NCPAP治疗小儿支气管肺炎并急性左心衰竭的效果及对心功能的改善作用分析

Analysis of effect of NCPAP on children with bronchial pneumonia complicated with acute left heart failure and improvement of cardiac function

目的探讨经鼻持续气道正压通气(NCPAP)治疗小儿支气管肺炎并急性左心衰竭的临床效果。方法 60例支气管肺炎并急性左心衰竭患儿,根据治疗方法不同分为观察组和对照组,各30例。观察组患儿给予基础治疗+NCPAP治疗,对照组患儿给予基础治疗+经鼻导管吸氧治疗。比较两组患儿治疗前后血气指标、心脏指数(CI)、左室射血分数(LVEF)、舒张早期二尖瓣血流最大流速与心房收缩期二尖瓣血流最大流速的比值(E/A)、心肌做功指数(Tei指数)、血清和肽素(CPP)、脑钠肽(BNP)水平。结果治疗前,两组患儿p H、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SaO2)比较差异无统计学意义(P>0.05)。治疗后,观察组患儿pH(7.36±0.05)、PaO2(87.6±5.4)mm Hg(1 mm Hg=0.133 kPa)、SaO2(95.2±2.0)%均高于对照组的(7.30±0.06)、(83.5±6.0)mm Hg、(93.0±2.5)%,PaCO2(34.2±3.8)mm Hg低于对照组的(37.0±4.1)mm Hg,差异有统计学意义(P<0.05)。治疗前,两组患儿CI、LVEF、E/A、Tei指数比较,差异无统计学意义(P>0.05);治疗后,观察组患儿CI(4.40±0.51)L/(min·m2)、LVEF(49.8±4.2)%高于对照组的(4.04±0.49)L/(min·m2)、(46.1±4.7)%, Tei指数(0.55±0.07)低于对照组的(0.59±0.08),差异有统计学意义(P<0.05)。治疗前,两组患儿CPP、BNP水平比较,差异无统计学意义(P>0.05);治疗后,观察组患儿CPP(8.2±2.6)pmol/L、BNP(167.4±55.1)pg/ml显著低于对照组的(10.4±3.1)pmol/L、(198.6±62.7)pg/ml,差异有统计学意义(P<0.05)。结论采用NCPAP治疗小儿支气管肺炎并急性左心衰竭能够有效改善患儿的心功能、血气水平,值得临床推广应用。

Objective To discuss the clinical effect of nasal continuous positive airway pressure (NCPAP) ventilation on children with bronchial pneumonia complicated with acute left heart failure. Methods A total of 60 children with bronchial pneumonia complicated with acute left heart failure were divided by different treatment methods into observation group and control group, with 30 cases in each group. The observation group was treated with basic therapy + NCPAP therapy, and the control group was treated with basic therapy + nasal catheter oxygen inhalation therapy. Comparison was made on blood gas index, cardiac index (CI), left ventricular ejection fraction (LVEF), ratio of maximal mitral flow velocity in early diastole to maximal mitral flow velocity in atrial systole (E/ A), myocardial work index (Tei index), serum copeptin (CPP), brain natriuretic peptide (BNP) levels before and after treatment between the two groups. Results Before treatment, there was no statistically significant difference in pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and blood oxygen saturation (SaO2) between the two groups (P>0.05). After treatment, the observation group had higher pH as (7.36±0.05), PaO2 as (87.6±5.4) mm Hg (1 mm Hg=0.133 kPa), SaO2 as (95.2±2.0)% than (7.30±0.06),(83.5±6.0)mm Hg and (93.0±2.5)% in the control group, and lower PaCO2 as (34.2±3.8) mm Hg than (37.0± 4.1)mm Hg in the control group. Their difference was statistically significant (P<0.05). Before treatment, there was no statistically significant difference in CI, LVEF, E/A and Tei index between the two groups (P>0.05). After treatment, the observation group had higher CI as (4.40±0.51) L/(min·m2) and LVEF as (49.8±4.2)% than (4.04±0.49) L/(min·m2) and (46.1±4.7)% in the control group, and lower Tei index as (0.55±0.07) than (0.59±0.08) in the control group. Their difference was statistically significant (P<0.05). Before treatment, there was no statistically significant difference in CPP and BNP between the two groups (P>0.05). After treatment, the observation group had significantly lower CPP as (8.2±2.6) pmol/L and BNP as (167.4±55.1) pg/ml than (10.4±3.1) pmol/L and (198.6±62.7) pg/ml in the control group, and their difference was statistically significant P<0.05). Conclusion NCPAP can effectively improve the heart function and blood gas level of children with bronchopneumonia and acute left heart failure, and it is worthy of clinical promotion and application.