CPAP在先天性心脏病合并重症肺炎心功能不全患儿中的应用

Application of continuous positive airway pressure in children with congenital heart disease combined with severe pneumonia and cardiac insufficiency

目的探讨持续正压通气(CPAP)在先天性心脏病合并重症肺炎心功能不全患儿中的作用。方法回顾分析130例先天性心脏病合并重症肺炎心功能不全的住院患儿的临床资料。根据治疗措施,将患儿分为CPAP组和对照组,分析治疗前及治疗后2、6、24小时呼吸频率(RR)、心率(HR)、治疗后左室射血分数(EF)的差异。结果CPAP组58例、对照组72例,两组的性别、年龄、体质量、主要临床症状、重要体征、影像学表现、治疗前血气指标、RR、HR及心功能不全治疗措施的差异均无统计学意义(P均>0.05)。治疗后2、6、24小时,两组RR和HR均较治疗前下降,差异有统计学意义(P均<0.05);治疗后2、6、24小时,CPAP组的RR和HR均低于对照组,差异有统计学意义(P均<0.05)。42例患儿治疗前后监测心功能(CPAP组17例、对照组25例);治疗前,两组EF差异无统计学意义(P>0.05),治疗后CPAP组的EF较对照组升高,差异有统计学意义(P<0.05)。结论CPAP可改善先天性心脏病合并重症肺炎心功能不全患儿临床症状、缩短住院时间,对心功能可能也有一定改善作用。

Objective To explore the role of continuous positive airway pressure(CPAP)in children with congenital heart disease combined with severe pneumonia and cardiac insufficiency.Methods The clinical data of 130 hospitalized children with congenital heart disease complicated with severe pneumonia and cardiac insufficiency were retrospectively analyzed.According to the treatment measures,the children were divided into CPAP group and the control group.The differences in respiratory rate(RR),heart rate(HR)and left ventricular ejection fraction(EF)before and after treatment were analyzed.Results There were 58 cases in CPAP group and 72 cases in control group.There was no difference in sex,age,weight,main clinical symptoms,important signs,imaging manifestations,blood gas index before treatment,RR,HR and treatment measures for cardiac insufficiency between the two groups(all P>0.05).At 2,6 and 24 hours after treatment,RR and HR of the two groups decreased compared with those before treatment,and the difference was statistically significant(P<0.05).The RR and HR of CPAP group were lower than those in the control group at 2,6 and 24 hours after treatment,and the difference was statistically significant(P<0.05).Cardiac function was monitored in 42 children before and after treatment,including 17 in the CPAP group and 25 in the control group.Before treatment,there was no significant difference in EF between the two groups(P>0.05).However,the EF of the CPAP group was higher than that of the control group after treatment,and the difference was statistically significant(P<0.05).Conclusions CPAP can improve the clinical symptoms and shorten the length of hospital stay in children with congenital heart disease complicated with severe pneumonia,and may also improve cardiac function.