Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia

Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.

Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series

Rationale: Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in pregnancy. Objectives: To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. Methods: We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 305/7 ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the paO2/FiO2 ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. Conclusion: The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.

Clinical efficacy of mask continuous positive airway pressure mechanical ventilation in children with severe pneumonia

Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.

Bi-level Nasal Positive Airway Pressure(BiPAP)versus Nasal Continuous Positive Airway Pressure(CPAP)for Preterm Infants with Birth Weight Less Than 1500g and Respiratory Distress Syndrome Following INSURE Treatment:A Two-center Randomized Controlled Trial

The present study aimed to examine the effectiveness of bi-level positive airway pressure(BiPAP)versus continuous positive airway pressure(CPAP)in preterm infants with birth weight less than 1500 g and respiratory distress syndrome(RDS)following intubation-surfactant-extubation(INSURE)treatment.A two-center randomized control trial was performed.The primary outcome was the reintubation rate of infants within 72 h of age after INSURE.Secondary outcomes included bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and incidences of adverse events.Lung function at one year of corrected age was also compared between the two groups.There were 140 cases in the CPAP group and 144 in the BiPAP group.After INSURE,the reintubation rates of infants within 72 h of age were 15%and 11.1%in the CPAP group and the BiPAP group,respectively(P>0.05).Neonates in the BiPAP group was on positive airway pressure(PAP)therapy three days less than in the CPAP group(12.6 d and 15.3 d,respectively,P<0.05),and on oxygen six days less than in the CPAP group(20.6 d and 26.9 d,respectively,P<0.05).Other outcomes such as BPD,NEC,ROP and feeding intolerance were not significantly different between the two groups(P>0.05).There was no difference in lung function at one year of age between the two groups(P>0.05).In conclusion,after INSURE,the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group.BiPAP was superior to CPAP in terms of shorter durations(days)on PAP support and oxygen supplementation.There were no differences in the incidences of BPD and ROP,and lung function at one year of age between the two ventilation methods.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease： a meta-analysis

Background The evidence for non-invasive positive pressure ventilation （NIPPV） used in patients with severe stable chronic obstructive pulmonary disease （COPD） is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life （HRQL）, survival and mortality in severe stable COPD patients. Methods Randomized controlled trials （RCTs） and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated. Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference （WMD） for the partial pressure of carbon dioxide in artery （PaCO2） was -3.52 （-5.26, -1.77） mmHg and for the partial pressure of oxygen in artery （PaO2） 2.84 （0.23, 5.44） mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference （SMD） for the forced expiratory volume in 1 second （FEV1） was 0.00 （0.29, 0.29）. And the benefits for exercise tolerance, mood, survival and mortality remained unclear. Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

Noninvasive Ventilation Interfaces in the Treatment of Acute Respiratory Insufficiency: A Critical Review

Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.

Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure

AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.

Effectiveness of adaptive servo-ventilation

Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.

Individualized Design of the Ventilator Mask based on the Residual Concentration of CO2

OSAHS(Obstructive Sleep Apnea Hypopnea Syndrome)is a respiratory disease mainly characterized by limited and repeated pauses of breathing in sleep.Currently,the optimal treatment is to apply CPAP(Continuous Positive Airway Pressure)ventilation on the upper airway of the patient through a household respiratory machine.However,if the ventilator mask is designed improperly,it might cause the residue and repeated inhalation of CO2,which will exert an adverse impact on the therapeutic effect.Present research numerically analyzed the CO2 transportation inside a commercial ventilator mask(Mirage SoftGel,ResMed,Australia)based on the reconstructed 3D numerical model of a volunteer's face and performed the improved design of the ventilator mask in terms of the CO2 residual concentration below the nostrils.The fluid dynamic analyses showed that at the end time of expiratory,the CO2 residual concentration below the nostrils is close to 4%.To improve the therapeutic effect,we changed the position of the exhaust holes and found that by moving the exhaust holes to the bottom of the ventilator mask,the CO2 residual concentration below the nostrils would be reduced to no more than 1%.This study established a near physiological computational model and provided a new method for the individualized design of the commercial ventilator mask.

Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil

BACKGROUND Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term.A preterm infant(PI)is classified when gestational age(GA)<37 wk.AIM To analyze prognostic indicators related to the use of oxygen therapy,noninvasive ventilation(continuous positive airway pressure)and mechanical ventilation(MV)in PI.METHODS This is a retrospective cohort.The sample was composed of PIs from a private hospital in southern Brazil.We included neonates with GA<37 wk of gestation in the period of January 1,2018 to December 31,2018.For data collection,electronic records were used in the Tasy Philips^(TM)system,identifying the variables:maternal age,type of birth,prenatal information,GA,Apgar score,birth weight,neonatal morbidities,vital signs in the 1st hour at birth,need for oxygen therapy,continuous positive airway pressure and MV,hospitalization in the neonatal intensive care unit,length of stay and discharge or death.RESULTS In total,90 PI records were analyzed.The median(p25-p75)of GA was 34.0(31.9-35.4)wk,and there were 45(50%)males.The most common morbidity among PIs was the acute respiratory discomfort syndrome,requiring hospitalization in the neonatal intensive care unit in 76(84.4%)cases.The utilization rate of oxygen therapy,continuous positive airway pressure and MV was 12(13.3%),37(41.1%)and 13(14.4%),respectively.The median(p25-p75)length of stay was 12.0(5.0-22.2)d,with 10(11.1%)deaths.A statistical association was observed with the use of MV and GA<28 wk,lower maternal age,low birth weight,Apgar<8 and neonatal deaths.CONCLUSION The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.

中医培土化浊方、针刺结合持续气道正压通气在阻塞性睡眠呼吸暂停低通气综合征患者中疗效分析

目的观察中医培土化浊方、针刺结合持续气道正压通气(CPAP)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的临床疗效。方法选取2020年5月—2022年5月收治的120例OSAHS患者作为研究对象,随机分为对照组(n=30)、药物+CPAP组(A组,n=29)、针刺+CPAP组(B组,n=27)以及联合组(n=34)共4组。对照组采用单独CPAP治疗,联合组采用培土化浊方内服+针刺+CPAP治疗,治疗周期为1个月。观察4组患者临床疗效,评估治疗前后4组患者中医证候积分、嗜睡程度、通气功能[呼吸暂停通气指数(AHI)、最低血氧饱和度(LSaO_(2))、最长呼吸暂停时间(LAT)]以及生活质量变化。结果治疗1个月后联合组临床疗效为94.12%,较对照组、A组以及B组临床疗效(72.41%、74.07%、56.67%)均明显更高(均P<0.05)。与治疗前比较,4组患者中医证候积分、嗜睡程度、通气功能以及生活质量均明显改善(均P<0.05),联合组中医证候积分、嗜睡程度评分、AHI以及LAT均低于对照组、A组与B组(均P<0.05),联合组LSaO_(2)以及生活质量评分均高于对照组、A组与B组(均P<0.05),对照组、A组与B组3组间中医证候积分、嗜睡程度评分、AHI、LSaO_(2)、LAT以及生活质量评分比较差异无统计学意义(均P>0.05)。结论中医培土化浊方、针刺结合CPAP联合治疗可有效提高OSAHS患者临床疗效,缓解其临床症状,提高通气功能,改善患者生活质量。

综合护理干预对阻塞性睡眠呼吸暂停低通气综合征患者生命质量的作用

目的:探讨综合护理干预对青海地区阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者生命质量的改善效果。方法:选取2019年1月至2021年12月在青海红十字医院睡眠医学科行多导睡眠监测(PSG)和无创呼吸机治疗的中重度OSAHS住院患者392例作为研究对象,根据收治的时间登记表单双号顺序将患者分为对照组(单号)和观察组(双号),每组196例。对照组给予普通护理,观察组给予综合护理。比较2组干预前后Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)、睡眠呼吸暂停生命质量指数(SAQLl)评分及干预后持续气道正压通气(CPAP)治疗依从性。结果:干预后,2组患者ESS、SAS评分均低于本组干预前(均P<0.05),且观察组干预后ESS、SAS评分均低于对照组(均P<0.05)。干预后,2组患者SAQLI日常活动、社会影响、情感活动、症状评分均高于本组干预前(均P<0.05),且观察组干预后SAQLI日常活动、社会影响、情感活动、症状评分均高于对照组(均P<0.05)。观察组干预后完成CPAP治疗患者例数明显多于对照组(P<0.05)。结论:综合护理干预后可显著提高患者CPAP治疗的依从性,提高疗效,提高患者的生命质量。

无创正压呼吸机治疗阻塞性睡眠呼吸暂停综合征对改善阿尔茨海默病血清生物标记物指标与认知功能的效果分析

目的:了解持续气道正压通气治疗是否可以改善阻塞性睡眠呼吸暂停综合征患者认知功能以及改善阿尔茨海默病重要生物标记物β-淀粉样蛋白1-42/1-40比值。方法:入选阻塞性睡眠呼吸暂停综合征患者56例,采用随机数字表法分为对照组、治疗组各28例。治疗组睡眠过程中给予持续正压无创呼吸机治疗结合有氧运动,对照组仅进行有氧运动,治疗6个月检测血清同型半胱氨酸水平、β-淀粉样蛋白1-42/1-40比值,并使用华山版听觉词语学习测验(auditory verbal learning test-Huashan version,AVLT-H)和动物词语流畅性量表(animal fluency test,AFT)来评估认知功能。结果:治疗6个月时,治疗组血清同型半胱氨酸水平、β-淀粉样蛋白1-42/1-40比值显著低于对照组(P<0.05);AVLT-H即刻回忆评分、AFT评分显著高于对照组(P<0.05)。结论:持续气道正压通气治疗可明显改善阻塞性睡眠呼吸暂停综合征患者的记忆和言语功能,并降低HCY和Aβ_(42)/Aβ_(40)比值,对阻塞性睡眠呼吸暂停综合征的认知障碍可能具有改善作用。

不同无创通气法治疗早产儿呼吸窘迫综合征的效果比较

目的比较无创高频振荡通气(NHFOV)、经鼻间歇正压通气(NIPPV)疗法、经鼻持续气道正压通气(NCPAP)治疗早产儿呼吸窘迫综合征(RDS)的效果。方法选取2021年1月至2022年12月贵港市人民医院收治的150例RDS早产儿,采用抽签法分为三组,每组各50例,分别给予NHFOV、NIPPV、NCPAP。比较三组呼吸情况与用氧情况、撤机成功率、血气指标、并发症发生情况。结果三组的无创呼吸时间、总用氧时间比较,差异无统计学意义(P>0.05)。NHFOV组的撤机成功率较高(P<0.05)。治疗前,三组血气指标比较,差异无统计学意义(P>0.05);治疗后,三组动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、氧合指数(P/F)比较,差异有统计学意义(P<0.05),NHFOV组的PaCO_(2)低于NIPPV组和NCPAP组,PaO_(2)、P/F高于NIPPV组和NCPAP组(P<0.05);三组pH值比较,差异无统计学意义(P>0.05)。三组并发症总发生率比较,差异无统计学意义(P>0.05)。结论与NIPPV、NCPAP相比,NHFOV可提升RDS早产儿撤机成功率,促进血气指标恢复。

不同无创通气联合枸橼酸咖啡因治疗早产儿呼吸暂停疗效分析

目的通过分析不同无创辅助通气模式联合枸橼酸咖啡因在早产儿呼吸暂停中的治疗效果,探讨治疗早产儿呼吸暂停的优化方案。方法选择2019年10月~2022年8月蚌埠医学院第二附属医院新生儿重症监护病房收治的90例胎龄≤34周的呼吸暂停患儿作为研究对象,回顾性分析患儿的病例资料,将患儿分为NCPAP联合枸橼酸咖啡因组(n=44)和NIPPV序贯NCPAP联合枸橼酸咖啡因组(n=46)。采用t检验、χ2检验、Mann-Whitney检验等,对两组患儿一般临床资料、呼吸暂停疗效、治疗时间及不良反应发生情况,进行统计学比较。结果NIPPV序贯NCPAP联合枸橼酸咖啡因组治疗早产儿呼吸暂停总有效率为91.30%,高于NCPAP联合枸橼酸咖啡因组的86.36%,差异有统计学意义(P<0.05);两组无创通气失败及相关治疗时间比较,差异有统计学意义(P<0.05);两组在喂养不耐受、鼻损伤发生情况比较,差异有统计学意义(P<0.05)。结论早期采用NIPPV序贯NCPAP的通气模式,较传统单用NCPAP治疗早产儿呼吸暂停,可以取得更好的临床效果,缩短治疗及住院时间,不良反应相对更少,值得临床推广。

连续气道正压通气对胸腔镜肺部手术患者呼吸功能的影响

目的探讨连续气道正压(CPAP)通气对胸腔镜肺部手术患者呼吸功能的影响。方法选择2021年6月至2022年12月于广西壮族自治区人民医院择期行胸腔镜肺部手术的60例患者,采用随机数字表法将其分为观察组和对照组,每组30例,经剔除后,最终两组各有29例纳入分析。在单肺通气时,观察组术侧肺持续给予CPAP通气,压力为5 cmH_(2)O,对照组术侧肺无特殊干预措施。于双肺通气20 min(T_(0))、单肺通气30 min(T_(1))、单肺通气1 h(T_(2))时间点进行动脉血气分析,比较两组各时间点氧合指数(OI)水平。比较两组术前及术后24 h中性粒细胞比率、白细胞计数。比较两组术后72 h内肺部并发症发生情况。结果在T_(0)~T_(2)时间点,两组OI均呈下降趋势(P<0.05),且在T_(1)、T_(2)时间点,对照组的OI水平较观察组更低,差异有统计学意义(P<0.05)。在手术后,两组白细胞计数、中性粒细胞比率较术前显著升高(P<0.05),两组间比较差异无统计学意义(P>0.05)。观察组术后肺部并发症发生率低于对照组,差异有统计学意义(13.79%vs 37.93%;χ^(2)=4.406,P=0.036)。结论对胸腔镜肺部手术患者的术侧肺实施CPAP通气能有效提高患者单肺通气时的氧合,降低术后肺部并发症发生率。

经鼻无创高频振荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中的应用

目的分析经鼻无创高频震荡通气联合经皮二氧化碳分压(TcPCO_(2))和经皮氧分压(TcPO_(2))监测在早产儿呼吸窘迫综合征中的应用。方法选择2019年10月至2021年10月收治的新生儿呼吸窘迫综合征无创呼吸支持治疗的早产儿80例,采用随机数字法分为改良组(经鼻无创高频震荡通气)和对照组(经鼻持续正压通气)。每组40例。2组均联合TcPCO_(2)和TcPO_(2)监测。观察2组通气0、6、12、24 h后的pH值、TcPCO_(2)/TcPO_(2)指标、无创通气时间、治疗失败转为气管插管机械通气率、并发症发生率及病死率。结果通气0 h,2组血液pH值、TcPCO_(2)、TcPO_(2)比较差异无统计学意义(P>0.05);与对照组比较,改良组通气6、12、24 h血液pH值、TcPO_(2)均明显升高,TcPCO_(2)均明显降低(P<0.05)。与对照组比较,无创通气时间和治疗失败转为气管插管机械通气率均明显降低(P<0.05)。2组气漏、腹胀、鼻部损伤、肺出血、感染性肺炎等并发症发生率比较差异无统计学意义(P>0.05)。对照组病死率为5.00%(2/40),改良组病死率为2.50%(1/40),差异无统计学意义(P>0.05)。结论经鼻无创高频震荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中应用价值较高,可改善患儿呼吸功能,降低气管插管机械通气率,且不会增加并发症的发生。