早期持续气道正压通气在小儿重症肺炎并发呼吸衰竭治疗中的应用效果

Application effect of early continuous positive airway pressure in the treatment of severe pneumonia complicated with respiratory failure in children

目的研究早期持续气道正压通气(CPAP)治疗小儿重症肺炎并发呼吸衰竭的临床疗效。方法160例小儿重症肺炎并发呼吸衰竭患儿,依据随机数字表法分为对照组与观察组,各80例。对照组给予常规治疗和面罩吸氧,观察组给予常规治疗和早期CPAP。比较两组治疗效果、治疗前后动脉血气指标[血氧饱和度(SaO_(2))、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))]、临床症状消失时间和住院时间、有创机械通气率及不良反应发生率。结果观察组治疗总有效率96.25%高于对照组的85.00%,差异有统计学意义(P<0.05)。治疗24 h时,观察组SaO_(2)(97.5±2.0)%、PaO_(2)(85.4±9.4)mm Hg(1 mm Hg=0.133 kPa)高于对照组的(90.2±2.5)%、(74.7±8.9)mm Hg,PaCO_(2)(43.3±2.9)mm Hg低于对照组的(47.2±3.1)mm Hg,差异均有统计学意义(P<0.05)。观察组肺啰音消失时间、发绀消失时间、呼吸困难症状消失时间、住院时间分别为(5.26±0.78)、(1.11±0.26)、(1.54±0.35)、(10.9±1.5)d,均短于对照组的(6.77±1.24)、(1.76±0.34)、(2.18±0.46)、(14.7±1.8)d,差异有统计学意义(P<0.05)。观察组有创机械通气率5.00%明显低于对照组的15.00%,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论小儿重症肺炎并发呼吸衰竭患儿早期应用CPAP治疗有助于快速改善呼吸通气状况,降低有创机械通气率,促进患儿临床症状缓解,且不良反应少,值得推广应用。

Objective To study the clinical efficacy of early continuous positive airway pressure(CPAP)in the treatment of severe pneumonia complicated with respiratory failure in children.Methods A total of 160 children with severe pneumonia complicated with respiratory failure were divided into control group and observation group according to the random numerical table,with 80 cases in each group.The control group received conventional treatment and mask oxygen inhalation,and the observation group received conventional treatment and early CPAP.Both groups were compared in terms of therapeutic effect,arterial blood gas indexes[blood oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],clinical symptoms disappearance time,hospitalization time,invasive mechanical ventilation rate and incidence of adverse reactions.Results The total effective rate 96.25%of the observation group was higher than 85.00%of the control group,and the difference was statistically significant(P<0.05).At 24 h of treatment,the SaO_(2)(97.5±2.0)%and PaO_(2)(85.4±9.4)mm Hg(1 mm Hg=0.133 kPa)in the observation group were higher than(90.2±2.5)%and(74.7±8.9)mm Hg in the control group;the PaCO_(2)(43.3±2.9)mm Hgthe observation group was lower than(47.2±3.1)mm Hg in the control group;the differences were all statistically significant(P<0.05).The disappearance time of lung rales,cyanochroia and dyspnea symptom,and hospitalization time of the observation group were(5.26±0.78),(1.11±0.26),(1.54±0.35),and(10.9±1.5)d,which were shorter than(6.77±1.24),(1.76±0.34),(2.18±0.46),and(14.7±1.8)d of the control group,and the differences were all statistically significant(P<0.05).The invasive mechanical ventilation rate in the observation group was 5.00%,which was significantly lower than 15.00%in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Early application of CPAP in children with severe pneumonia complicated by respiratory failure can help to rapidly improve respiratory ventilation,reduce the rate of invasive mechanical ventilation,and promote the relief of clinical symptoms in children with few adverse reactions,which is worthy of promotion and application.