经鼻持续正压通气治疗中-重度毛细支气管炎的临床研究

Clinical medical research of nasal continuous positive airway pressure in moderate to severe capillary bronchitis

目的探讨经鼻持续正压通气(nasal continuous positive airway pressure,nCPAP)治疗中-重度毛细支气管炎的有效性及安全性。方法前瞻性观察符合nCPAP使用标准的中-重度毛细支气管炎患儿120例,剔除数据不完整病例4例,最终纳入116例。根据临床转归分为治疗成功组和未成功组,于治疗前和治疗后2 h、24 h、48 h比较2组动脉血氧分压(partial pressure of oxygen,PaO2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO2)、PaO2/吸入氧浓度(fraction of inspiration O2,FiO2)、呼吸频率、心率。结果nCPAP治疗成功组108例(93.1%);未成功组8例(6.9%),均改为气管插管行有创机械通气。治疗前,未成功组PaO2、PaO2/FiO 2明显低于成功组,PaCO2明显高于成功组(P<0.05)。成功组治疗后呼吸频率、心率、PaCO2逐渐降低,PaO2、PaO2/FiO2逐渐升高(P<0.05)。所有患儿对nCPAP耐受良好,无不良事件发生。结论应用nCPAP治疗中-重度毛细支气管炎效果显著,安全性高,能有效改善患儿氧合、缓解其高碳酸血症,但对于存在严重低氧血症、CO2潴留明显的患儿,需尽早选择有创通气。

Objective To investigate the safety and efficiency of nasal continuous positive airway pressure(nCPAP)in moderate to severe capillary bronchitis.Methods This was a prospective study.Children who were admitted with moderate to severe capillary bronchitis and met the nCPAP ventilation indications.A total of 120 children were included,4 cases with incomplete data were excluded,and 116 cases were finally included.According to clinical outcomes,the two groups were divided into the successful group and the unsuccessful group.The differences in partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),PaO2/fraction of inspiration O2(FiO2),breath and heart rate of the two groups were compared between pre-nCPAP and post-nCPAP at 2 h,24 h and 48 h.Results A total of 108 cases(93.1%)were successfully treated with nCPAP.Eight cases(6.9%)in the unsuccessful group were changed to treat by airway intubation and mechanical ventilation.PaO2,PaO2/FiO2 pre-nCPAP were lower,and PaCO2 were higher in nCPAP unsuccessful group(P<0.05).After nCPAP treatment,breath and heart rate,PaCO2 of the children in the successful group were significantly decreased(P<0.05).PaO2,PaO2/FiO2 were significantly increased(P<0.05).All children had good tolerance to nCPAP and no adverse events occurred.Conclusion nCPAP treatment has significant efficacy and high safety,and can effectively improve oxygenation and relieve hypercapnia in children.However,for children with severe hypoxia and obvious carbon dioxide retention,invasive ventilation should be selected as soon as possible.