经鼻持续气道正压通气优先策略治疗毛细支气管炎的随机对照研究

A clinical randomized controlled trials on nCPAP as priority strategy in bronchiolitis

目的:探讨经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)优先策略对毛细支气管炎的氧合及通气功能、气管插管率及住在儿科重症监护病房(pediatric intensive care unit,PICU)时间的影响。方法:按是否优先采用nCPAP策略,将符合研究标准的患儿随机分为非优先组与优先组。非优先组予以雾化、吸痰、吸氧等处理,具有气管插管指征时,行气管插管。优先组予以雾化、吸痰后即应用nCPAP,具有气管插管指征时行气管插管。结果:非优先组住PICU的时间为(101.07±18.68)h,优先组住PICU的时间为(98.28±13.74)h(P>0.05)。非优先组气管插管率26.19%,优先组气管插管率5.56%(P<0.05),但5≦CSS<9时,气管插管率无显著性差异(P>0.05)。两组治疗成功的患儿中,优先组在治疗12 h及24 h,Pa CO2、PaO_2/FiO_2均较治疗前改善(P<0.05);非优先组Pa CO2、PaO_2/FiO_2在治疗2 h、12 h与治疗前比较,均无明显改善(P>0.05),但两组间比较PaCO_2、FiO_2/PaO_2在12 h、24 h,优先组均较非优先组明显改善(P<0.05)。结论:nCPAP能有效改善毛细支气管炎的氧合情况及换气功能,减少气管插管的几率,并不延长毛细支气管炎住在PICU的时间。但对于呼吸窘迫不太严重的毛细支气管炎,可能不需要nCPAP优先策略呼吸支持。

Objective：To investigate the influence of nasal continuous positive airway pressure（nCPAP） as priority strategy in treatment of bronchitis, such as oxygenation, ventilation function, strategy trachea intubation rate and in PICU time. Methods ： According to whether or not treat with nCPAP as priority strategy,infants were divided into non priority group and priority group randomly. In non priority group infants were given atomization, sputum, nasal catheter or oxygen mask after admission to PICU. When endotracheal intuba- tion indications were present,infants were given mechanical ventilation. In priority group infants were given atomization and sputum suc- tion after admission to PICU,then teated with nCPAP in the first time. When endotracheal intubation indications were present, infants were given mechanical ventilation. Resnlts：PICU times were （ 101.07 - 18.68） h in non priority group,and PICU times were （98.28 -＋ 13.74） h in priority grou （P 〉 0.05 ）. Intubation rate was 26. 19% in non priority group, and intubation rate was 5.56% in priority group （P 〈0.05）. However, while 5 _-〈 CSS 〈 9,there is no significant difference in tracheal intubation rates betweevn non priority group and priority group（ P 〉 0.05 ）. Two groups of children with the success of the treatment, the priority group in the treatment of 12 h and 24 h, PaCO2 and PaO2/FiO2 were better than those before treatment （P 〈 0.05 ） , non priority group PaCO2 , PaOJFiO2 in the treat- ment of 2 h and 12 h compared with before treatment,there was no obvious improvement （P 〉 0.05） ,but the comparison between the two groups PaCO2 ,PaO2/FiO2 in 12 h and 24 h the priority group was significantly improved compared with the non priority group （P 〈 0.05 ）. Conclusion ： nCPAP can effectively improve the oxygenation and gas exchange function of bronchitis, nCPAP as priority strategy may reduce the rate of airway intubation in bronchiolitis and does not prolong the time of bronchitis in PICU. Howere, for infants with no severe respiratory distress,those infants＂ may not require nCPAP as priority strategy for respiratory support.