Acapella振动正压通气联合高频胸壁振荡排痰在治疗儿童重症肺炎中的应用价值

Application of Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion in the treatment of severe pneumonia in children

目的分析Acapella振动正压通气联合高频胸壁振荡排痰治疗在儿童重症肺炎中的应用价值,为重症肺炎患儿治疗方案的制定提供理论参考.方法选择2022年4月至2023年4月温州医科大学附属第二医院儿童呼吸科接诊的120例重症肺炎患儿作为研究对象.根据治疗方案的不同将患儿分为传统气道廓清术组、Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组及Acapella振动正压通气联合高频胸壁振荡排痰治疗组,每组30例.比较各组患儿肺炎症状缓解时间和住院时间,以及治疗前后肺功能指标、炎症因子水平的差异.结果Acapella振动正压通气联合高频胸壁振荡排痰治疗组患儿肺部啰音消失时间、体温恢复正常时间、咳嗽缓解时间及住院时间均较传统气道廓清术组、Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组明显缩短[肺部啰音消失时间(d):4.85±0.78比8.47±2.36、5.22±2.12、5.38±1.56,体温恢复正常时间(d):3.51±1.04比7.84±2.34、4.45±1.92、4.76±1.59,咳嗽缓解时间(d):7.45±2.15比13.59±4.08、8.88±3.35、8.72±2.59,住院时间(d):3.78±0.63比8.29±2.07、5.02±1.44、4.96±1.25,均P<0.01],Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组患儿肺部啰音消失、体温恢复正常、咳嗽缓解及住院时间均较传统气道廓清术组明显缩短(均P<0.01).4组治疗后1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC均较治疗前明显升高,炎症因子肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC)均较治疗前明显降低,且治疗后Acapella振动正压通气联合高频胸壁振荡排痰治疗组FEV1、FCV和FEV1/FVC均明显高于传统气道廓清术组、Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组[FEV1(L):3.65±1.33比2.28±0.45、2.94±0.63、2.99±0.72,FVC(L):4.56±1.84比2.94±0.83、3.46±1.28、3.65±1.34,FEV1/FVC:(72.36±8.84)%比(59.84±4.05)%、(62.35±5.22)%、(64.59±5.58)%,均P<0.01];Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组患儿肺功能指标均明显高于传统气道廓清术组(均P<0.01);治疗后Acapella振动正压通气联合高频胸壁振荡排痰治疗组血清炎症因子水平均明显低于传统气道廓清术组、Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组[TNF-α(ng/L):14.62±4.55比29.44±6.13、18.09±5.33、17.52±4.42,hs-CRP(mg/L):21.41±3.65比48.67±8.39、40.24±6.42、37.24±5.12,WBC(×10^(9)/L):13.42±3.67比19.29±6.45、15.43±5.34、14.22±4.14,均P<0.01],Acapella振动正压通气治疗组、高频胸壁振荡排痰治疗组血清炎症因子水平均明显低于传统气道廓清术组(均P<0.01).结论Acapella振动正压通气联合高频胸壁振荡排痰治疗儿童重症肺炎疗效确切,能明显缩短患儿咳痰好转时间及住院时间,降低炎症因子水平,改症患儿肺功能,有利促进患儿康复进程.

Objective To analyze the application value of Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion in children with severe pneumonia,and provide theoretical reference for the formulation of treatment plans for severe pneumonia.Methods From April 2022 to April 2023,120 children with severe pneumonia were selected from the Children's Respiratory Department of the Second Affiliated Hospital of Wenzhou Medical University.According to different treatment plans,the children were divided into traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,and Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group,with 30 cases in each group.The duration of pneumonia symptom remission and hospitalization,as well as the difference of pulmonary function index and inflammatory factors before and after treatment were compared.Results Compared with traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,the disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief and the length of stay of children in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscllation treatment group were significantly shortened[the disappearance time of pulmonary rales(days):4.85±0.78 vs.8.47±2.36,5.22±2.12,5.38±1.56,the recovery time of body temperature(days):3.51±1.04 vs.7.84±2.34,4.45±1.92,4.76±1.59,the time of cough relief(days):7.45±2.15 vs.13.59±4.08,8.88±3.35,8.72±2.59,the length of stay(days):3.78±0.63 vs.8.29±2.07,5.02±1.44,4.96±1.25,all P<0.05].The disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief,and the length of stay in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were shorter than those in traditional airway clearance group(all P<0.05).Forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and FEVi/FVC afer treatment were significantly higher than before treatment,and the inflammatory factors tumor necrosis fact-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)and white blood cell count(WBC)were significantly lower than before treatment.After treatment,FEV1,FCV and FEV1/FVC in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly higher than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group[FEV1(L):3.65±1.33 vs.2.28±0.45,2.94±0.63,2.99±0.72,FVC(L):4.56±1.84 vs.2.94±0.83,3.46±1.28,3.65±1.34,FEV1/FVC:(72.36±8.84)%vs.(59.84±4.05)%,(62.35±5.22)%,(64.59±5.58)%,all P<0.05].The pulmonary function indexes of children in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were higher than those in traditional airway clearance group(all P<0.05).After treatment,the levels of serum inflammatory factors in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly lower than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscilation treatment group[TNF-α(ng/L):14.62±4.55 vs.29.44±6.13,18.09±5.33,17.52±4.42,hs-CRP(mg/L):21.41±3.65 vs.48.67±8.39,40.24±6.42,37.24±5.12,WBC(×10^(9)/L):13.42±3.67vs.19.29±6.45,15.43±5.34,14.22±4.14,all P<0.05],the serum inflammatory factor indexes of Acapella positive expiratory pressure therapy group,highfrequency chest wall oscillation treatment group were lower than those of traditional airway clearance group(all P<0.05).Conclusion Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion is effective in the treatment of severe pneumonia in children,which can shorten the time of sputum improvement and hospital stay,reduce the level of inflammatory factors,improve the pulmonary function of the children,and promote the rehabilitation process of the children.