经鼻塞式持续性气道正压通气联合小剂量糖皮质激素对重症肺炎患儿血气指标及炎性因子水平的影响

Effects of nasal continuous positive airway pressure combined with low dose glucocorticoid on blood gas parameters and inflammatory factors in children with severe pneumonia

目的 探讨经鼻塞式持续性气道正压通气（NCPAP）联合小剂量糖皮质激素对重症肺炎患儿血气指标及炎性因子水平的影响.方法 抽取2015年2月至2016年4月74例重症肺炎患儿,通过随机数字表法将其分为两组,每组37例.对照组采用面罩给氧治疗,研究组采用NCPAP＋布地奈德混悬液治疗.比较两组临床疗效、并发症发生率,并分析临床症状消失时间及治疗前后血气指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血氧饱和度（SaO2）]、炎性因子[C-反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）]水平变化情况.结果 研究组治疗有效率（91.89%）高于对照组（72.97%）,差异有统计学意义（P〈0.05）;研究组肺部啰音、胸骨凹陷、心律异常、发绀、呼吸困难消失时间少于对照组,差异有统计学意义（P〈0.05）.治疗前两组PaCO2、SaO2、PaO2水平比较差异未见统计学意义（P〉0.05）;治疗后两组各指标水平均有所改善,且研究组PaCO2水平低于对照组,SaO2、PaO2水平高于对照组,差异有统计学意义（P〈0.05）.治疗前两组CRP、IL-6、IL-8、TNF-α水平比较差异未见统计学意义（P〉0.05）,治疗后两组各指标水平均较治疗前降低,且研究组低于对照组,差异有统计学意义（P〈0.05）.研究组并发症发生率（8.11%）低于对照组（27.03%）,差异有统计学意义（P〈0.05）.结论 联合采用经鼻塞式持续性气道正压通气及小剂量糖皮质激素治疗重症肺炎患儿效果显著,可减少临床症状缓解时间,改善血气指标,降低炎性因子水平,提高治疗效果,且并发症发生率较低,具有安全性.

Objective To investigate the effects of nasal continuous positive airway pressure （NCPAP） combined with low dose glucocorticoid on blood gas parameters and inflammatory factors in children with severe pneumonia.Methods Seventy-four children with severe pneumonia from February 2015 to April 2016 were randomly divided into study group and control group, with 37 cases in each group.The control group was treated by mask oxygen therapy, and the study group was treated by NCPAP＋ budesonide suspension.Statistical comparison of the clinical efficacy, incidence of complications, analyzed the disappearance time of clinical symptoms and blood gas [arterial oxygen pressure （PaO2）, carbon dioxide partial pressure （PaCO2）, blood oxygen saturation （SaO2）]before and after treatment, the inflammatory factors [C-reactive protein （CRP）, interleukin-6（IL-6）, interleukin-8（IL-8） and tumor necrosis factor-α （TNF-α）] were measured.Results Clinical efficacy： the effective rate of the treatment group （91.89%） was higher than that of the control group （72.97%）, the difference was significant （P〈0.05）.Clinical symptoms： the lung rales, sternal depression, cardiac rhythm abnormalities, cyanosis and dyspnea time of study group were less than those in the control group, the differences were significant （P〈0.05）.Blood gas indexes： there was no significant difference in the PaCO2, SaO2 or PaO2 level between the two groups before treatment （P〉0.05）;After treatment, the levels of the two groups were improved, but the PaCO2 level in the study group was lower than that in the control group, SaO2 and PaO2 level were higher than those in the control group, the differences were significant （P〈0.05）.Inflammatory factors： there was no significant difference in the levels of CRP, IL-6, IL-8 or TNF-α between the two groups before treatment （P〉0.05）;After treatment, the levels of each index were lower than those before treatment, but the study group was lower than that in the control group, the difference was significant （P〈0.05）.Complications： the incidence of complications in the study group （8.11%） was significantly lower than that in the control group （27.03%, P〈0.05）.Conclusions The combination of continuous nasal continuous positive airway pressure and low dose glucocorticoid has significant effect on children with severe pneumonia, it can reduce the clinical symptoms of remission time, improve blood gas index, reduce inflammatory factor levels, improve the treatment effect, decrease concurrent disease incidence and with high safety.