经鼻持续气道正压优先策略治疗肺血多先心病的临床研究

Nasal positive airway pressure priority strategy for treating infants with congenital heart disease

目的 调查优先鼻塞持续气道正压 (NCPAP)优先策略对肺血多先天性心脏病 (先心病 )的心肺功能支持作用和长期疗效。方法 对 1994年 1月～ 2 0 0 1年 12月住我院PICU符合下列条件的先心病病人进行回顾性分析 :1.年龄 <3岁。 2 .室间隔缺损 (VSD)、房间隔缺损 (ASD)和动脉导管未闭 (PDA)或上述联合畸形的先心病。 3.入院临床资料完整 ,符合心衰或心衰伴呼衰诊断标准。 4 .除外其他复杂畸形、急诊室行心肺复苏术或入院 2 4h内死亡病例。分别以 1995年 1月～ 1997年 12月和 1998年 1月～ 2 0 0 1年 12月为先心病常规治疗组 (常规组 )和NCPAP优先策略组 (优先组 ) ,观察优先组NCPAP对心肺功能短时作用和比较两组病死率、气管插管机械通气应用率和时间。结果 常规组 6 2例 ,应用NCPAP 10例 (占 16 .1% ) ;优先组 117例 ,均应用NC PAP ,4 1例短时疗效显示 :心率由 175± 2 8次 /min降至 14 8± 17次 /min(P <0 .0 1) ;呼吸频率由 6 9± 9次 /min下降至 5 4± 8次 /min (P <0 .0 1) ;PaO2 /FiO2 从 16 2± 5 4 .7升至 2 6 5± 39.0 (P <0 .0 5 ) ;PaCO2 由 5 4 .9± 2 2 .9mmHg降至 5 3.1± 17.3mmHg(P >0 .0 5 ) ;pH值由 7.2 77± 0 .0 87上升至 7.2 94± 0 .0 70 (P >0 .0 5 )。两组长期疗效比较 ,病死率和?

Objective To investigate the cardio pulmonary efficacy and long term outcome of nasal positive airway pressure (NCPAP) priority strategy for treating infants with congenital heart disease.Methods All patients in PICU from Jan 1994 to Dec 2001 were respectively analyzed . The criteria entered the study were:1.the age less than 3 year,2.congenital heart disease (CHD) with ventricular septal defeet, atrial septal defeet, patent ductus arteriosus, 3.combined heart failure,4.excluding patents of cardio pulmonary resuscitation or death within 24 hours in admission. Patients from Jan 1995 to Dec 1997 and from Jan 1998 to Dec 2001 were divided into two groups: routing group and NCPAP priority group.Results Sixty two patients in routing group, 10 cases applied with NCPAP; and 117 patients in NCPAP priority group were applied with NCPAP. Short term efficacy of NCPAP in 41 cases showed that heart rate decreased from 175 ±28/min to 148 ±17/min( P <0.01), respiratory rate decreased from 69 ±9 to 54 ±8( P <0.01);PaO 2/FiO 2 increased from 162±54.7 to 265±39.0 mmHg ( P <0.05);PaCO 2 decreased from 54.9± 22.9 mmHg to 53.1±17.3 mmHg ( P >0.05); Compared with routing group, the frequency of mechanically ventilation reduced from 32.3 % to 18.8 %. Conclusions NCPAP suggest significant cardio pulmonary support effect in treating infants with congestive heart failure. NCPAP-priority strategy may significantly decrease the frequency of mechanically ventilation.