经鼻持续气道正压通气联合丙种球蛋白对新生儿重症肺炎合并心力衰竭的疗效观察

Curative effects of nasal continuous positive airway pressure combined with immunoglobulin on neonatal severe pneumonia combined with heart failure

目的探讨经鼻持续气道正压通气(NCPAP)联合丙种球蛋白对新生儿重症肺炎合并心力衰竭的疗效。方法收治的65例重症肺炎合并心力衰竭新生儿随机分为治疗组33例和对照组32例,2组患儿均给予常规治疗,对照组在此基础上给予丙种球蛋白400 mg·kg^(-1)·d^(-1)静脉滴注,观察组在对照组基础上联合应用NCPAP治疗。比较2组治疗前和治疗24 h后心率(HR)、呼吸频率(RR)、经皮血氧饱和度(SpO_2)、动脉血气pH值、氧分压(PaO_2)和二氧化碳分压(PaCO_2)以及血清N末端脑钠肽(NT-proBNP)、心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)水平的变化;统计气促消失、心率恢复正常、肺部啰音消失、肝脏回缩和动脉血气恢复正常的时间以及平均住院时间,治疗7 d后判定2组总体疗效。结果治疗24 h后治疗组HR、RR和PaCO_2及血清NT-proBNP、cTnI和CK-MB水平均显著低于对照组(P<0.05或<0.01),SpO_2、PaO_2均显著高于对照组(P<0.01)。治疗组患儿气促消失、心率恢复正常、肺部啰音消失、肝脏回缩和动脉血气恢复正常的时间以及平均住院时间均显著短于对照组(P<0.01)。治疗组显效率为90.91%显著高于对照组的71.88%(P<0.05)。结论联合应用NCPAP和丙种球蛋白可更有效控制重症肺炎合并心力衰竭新生儿的低氧血症和高碳酸血症,有利于心肺功能的恢复,缩短病程。

Objective To explore the curative effects of nasal continuous positive airway pressure(NCPAP) combined with immunoglobulin on neonatal severe pneumonia combined with heart failure. Methods A total of 65 neonates with severe pneumonia complicated by heart failure who were admitted and treated in our hospital were randomly divided into treatment group(n=33) and control group(n=32). The patients in both groups received routine treatment, on this basis, the patients in control group were treated by intravenous drip with immunoglobulin 400 mg·kg-1·d-1,however,the patients in observation group,on the basis of control group,were treated by NCPAP. The changes of heart rate(HR), respiratory rate(RR), percutaneous oxyhemoglobin saturation(SpO2), the pH value of arterial blood gases, oxygen partial pressure(PaO2) and partial pressure of carbon dioxide(PaCO2), serum N terminal brain natriuretic peptide(NT-proBNP), cardiac troponin I(cTnI) and creatine kinase isoenzyme(CK-MB) before and 24 h after treatment were observed and compared between the two grousp.Moreover the time of polypnea disappearing, heart rate recovery, pulmonary rales disappearing, liver retraction, arterial blood gas recovery and average length of staing in hospital were observed and compared between the two grousp.The overall curative effects at 7 d after treatment were evaluated in both groups. Results At 24 h after treatment the levels of HR, RR, PaCO2, serum NT-proBNP, cTnI and CK-MB in treatment group were significantly lower than those in control group(P<0.05 or P<0.01), however the levels of SpO2 and PaO2 in treatment group were significantly higher than those in control group(P<0.01). The time of polypnea disappearing, heart rate recovery, pulmonary rales disappearing, liver retraction, arterial blood gas recovery and average length of staing in hospital in treatment group were significantly shorter than those in control group(P<0.01). The marked effective rate in treatment group was significantly higher than that in control group(90.91% vs 71.88%, P<0.05). Conclusion NCPAP combined with immunoglobulin can more effectively control the hyoxemia and hypercapnia in neonates with severe pneumonia complicated by heart failure, which is in favor of recovery of cardio-pulmonary function and shortening the course of disease.