经鼻持续气道正压通气优先支持策略在婴儿重症肺炎中的实践

Application of nasal continuous positive airway pressure preferential ventilation strategy in the treatment of infant severe pneumonia

目的：探讨经鼻持续气道正压通气（NCPAP）优先支持策略在婴儿重症肺炎中的治疗价值。方法对59例婴儿重症肺炎使用NCPAP优先支持策略，评价治疗效果。结果 NCPAP治疗有效50例，无效9例。有效组和无效组治疗前月龄、呼吸频率（RR）、心率（HR）比较差异无统计学意义（P＞0.05）；但无效组动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）显著高于有效组，动脉血氧分压（PaO2）显著低于有效组，差异均有统计学意义（P＜0.05）。50例对NCPAP治疗有效患儿治疗后1、12、24 h PaO2、PaO2/FiO2显著上升（P＜0.05），PaCO2、RR、HR显著下降（P＜0.01）。结论 NCPAP优先支持策略能够减少有创呼吸机的使用，改善氧合，缓解呼吸困难，稳定生命体征。

Objective To investigate the value of nasal continuous positive airway pressure （NCPAP） in the treatment of severe pneumonia. Methods The clinical data of 59 severe pneumonia infants who received NCPAP preferential ventilation strategy were retrospectively analyzed. Results After treatment, 50 infants were effective and 9 infants were ineffective. Before treatment, the age, RR, HR between effective group and ineffective group had no significant differences （P〉0.05）. But the levels of PaCO2, PaO2/FiO2 in ineffective group were significantly higher than those in effective group and the level of PaO2 in ineffective group was significantly lower than that in effective group （P〈0.05）. In effective group, the levels of PaO2 and PaO2/FiO2 were significantly increased after treatment for 1, 12 and 24 h, and the levels of PaCO2, RR and HR were significantly decreased （P〈0.01）. Conclusions NCPAP preferential ventilation strategy can reduce the use of invasive mechanical ventilation, improve oxygenation, ease dyspnea and make vital signs stable.