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

Effect of the nasal continuous positive airway pressure combined with small dose of corticosteroid on the blood gas index and inflammatory cytokine level in children with severe pneumonia

目的:观察和分析经鼻式持续性气道正压通气联合小剂量糖皮质激素治疗前后重症肺炎患儿血气指标和炎性因子水平的影响。方法:选取78例重症肺炎患儿作为研究对象,根据治疗方案的不同分为观察组和对照组,各39例。2组患儿入院后均给予常规儿科重症监护室监护和药物治疗,在此基础上观察组患儿给予经鼻式持续性气道正压通气联合小剂量糖皮质激素治疗,对照组患儿则给予常规鼻导管吸氧,观察2组患儿治疗前后血气分析和部分炎性因子的水平变化,并对观察结果进行统计分析。结果:治疗后,2组患儿氧分压(PaO_2)、氧饱和度(SaO_2)和pH水平均明显高于治疗前,二氧化碳分压(PaCO_2)水平较治疗前明显降低(P<0.01);且观察组患儿PaO_2、SaO_2和pH水平均明显高于对照组,而PaCO_2水平则明显低于对照组(P<0.01)。治疗后2组患儿IL-10水平较治疗前明显升高,C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α以及可溶性细胞间黏附因子(sICAM-1)水平较治疗前明显降低(P<0.01)。治疗后观察组患儿IL-10、CRP、TNF-α以及sICAM-1水平均明显高于对照组(P<0.01)。结论:经鼻塞式持续性气道正压通气联合小剂量糖皮质激素治疗重症肺炎患儿可调节相关炎性因子水平,进一步改善患儿的缺氧情况,恢复酸碱平衡。

Objective:To observe the effects of the nasal continuous positive airway pressure(CPAP)combined with small dose of corticosteroid on the blood gas index and inflammatory cytokine level in children with severe pneumonia.Methods:Seventy-eight children with severe pneumonia were divided into the observation group and control group according to the different treatment(39 cases each group).Two groups were treated with the conventional PICU ward care and drug treatment after admission,and the observation group and control group were additionally treated with the nasal CPAP combined with small dose of glucocorticoid and conventional nasal catheter oxygen intake,respectively.The changes of the blood gas index and inflammatory cytokine level in two groups between before and after treatment were compared.Results:After treatment,the levels of PaO 2,SaO 2 and pH significantly increased,and the level of PaCO 2 significantly decreased in two groups compared before treatment(P<0.01).After treatment,the levels of PaO 2 and SaO 2 and pH in observation group were significantly higher than those in control group,and the PaCO 2 level in observation group was significantly lower than that in control group(P<0.01).After treatment,the level of IL-10 significantly increased,and the levels of CRP,TNF-αand sICAM-1 significantly decreased in two groups compared before treatment(P<0.01).After treatment,the levels of IL-10,CRP,TNF-αand sICAM-1 in observation group were significantly higher than those in control group(P<0.01).Conclusions:The nasal CPAP combined with small dose of corticosteroid in the treatment of severe pneumonia can improve the hypoxia and restore the acid-base balance by regulating the related inflammatory cytokine level in the short-term,which is superior to the conventional treatment