持续气道正压治疗左向右分流型先天性心脏病合并重症肺炎患儿的临床效果

Clinical Effect of Continuous Positive Airway Pressure in the Treatment of Children with Left-to-right Shunt Congenital Heart Disease Complicated with Severe Pneumonia

目的:探讨持续气道正压(CPAP)治疗左向右分流型先天性心脏病(CHD)合并重症肺炎患儿的临床效果。方法:回顾性选取2021年11月—2023年4月贵州省人民医院PICU收治的107例左向右分流型CHD合并重症肺炎患儿作为研究对象。根据治疗方法的不同将其分为试验组(n=26)和对照组(n=81)。两组均给予常规治疗,试验组采用CPAP治疗,对照组采用鼻导管吸氧治疗。比较两组治疗前30min(治疗前)及治疗1d后血气分析指标、相关临床指标、时间指标。结果:治疗1 d后,两组血乳酸(Lac)、动脉血二氧化碳分压(PaCO_(2))均降低,氧合指数升高,试验组Lac、PaCO_(2)均低于对照组,氧合指数高于对照组,差异有统计学意义(P<0.05)。治疗1 d后,两组心率(HR)、呼吸频率(RR)均降低,试验组HR、RR均低于对照组,治疗7 d后,两组钠尿肽(BNP)降低,试验组BNP低于对照组,两组左室射血分数(LVEF)升高,试验组LVEF高于对照组,差异有统计学意义(P<0.05)。试验组入住PICU时间、呼吸困难及精神症状改善时间均短于对照组,差异有统计学意义(P<0.05)。结论:CPAP在左向右分流型CHD合并重症肺炎患儿中具有明显的临床效果,可以有效改善左心功能,缩短住院时间及临床症状持续时间。

Objective:To investigate the clinical effect of continuous positive airway pressure(CPAP)in the treatment of children with left-to-right shunt congenital heart disease(CHD)complicated with severe pneumonia.Method:A retrospective study was conducted on 107 children with left-to-right shunt CHD complicated with severe pneumonia admitted to the PICU of Guizhou Provincial People's Hospital from November 2021 to April 2023.They were divided into experimental group(n=26)and control group(n=81)according to different treatment methods.Both groups received conventional treatment,with the experimental group receiving CPAP therapy and the control group receiving nasal catheter oxygen inhalation therapy.Blood gas analysis indicators,relevant clinical indicators 30 min before treatment(pre-treatment)and 1 d after treatment,time indicators were compared between the two groups.Result:After 1 d of treatment,blood lactic acid(Lac)and arterial blood partial pressure of carbon dioxide(PaCO_(2))in both groups were decreased,and oxygenation index was increased,Lac and PaCO_(2) in experimental group were lower than those in control group,and oxygenation index was higher than that in control group,the differences were statistically significant(P<0.05).After 1 d of treatment,the heart rate(HR)and respiratory rate(RR)of both groups were decreased,and the HR and RR of the experimental group were lower than those of the control group;after 7 d of treatment,natriuretic peptide(BNP)of both groups was decreased,BNP of the experimental group was lower than that of the control group,left ventricular ejection fraction(LVEF)of both groups were increased,and LVEF of the experimental group was was higher than that of the control group,the differences were statistically significant(P<0.05).The PICU check-in time,the improvement time of dyspnea and mental of experimental group were shorter than those of control group,the differences were statistically significant(P<0.05).Conclusion:CPAP has significant clinical effects in children with left-to-right shunt CHD complicated with severe pneumonia,and can effectively improve left ventricular function,shorten hospital stay,and reduce the duration of clinical symptoms.