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.

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.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(P<0.05);after treatment,the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group,and the difference showed a highly significant correlation(P<0.001).Conclusion:The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect,effectively controls the level of inflammatory factors,and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure,showing a good clinical application prospect.

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。

无创正压通气在重症支气管哮喘合并呼吸衰竭急诊治疗中的效果评价

目的 观察无创正压通气在重症支气管哮喘合并呼吸衰竭急诊治疗中的效果。方法 62例重症支气管哮喘合并呼吸衰竭患者,遵循双盲随机分组原则分为对照组和实验组,各31例。两组患儿均给予常规治疗,对照组在常规治疗基础上采用有创正压通气治疗,实验组在常规治疗基础上采用无创正压通气治疗。比较两组患者基本生命指征、炎症指标、血气分析指标、并发症发生情况。结果 治疗24 h后,实验组心率(96.65±7.14)次/min低于对照组的(112.32±7.11)次/min,收缩压(125.65±4.67)mm Hg(1 mm Hg=0.133 kPa)、舒张压(85.45±3.54)mm Hg均高于对照组的(120.54±4.69)、(73.16±3.51)mm Hg(P<0.05)。治疗24 h后,实验组C反应蛋白、白细胞介素-6、白细胞介素-17分别为(8.54±1.43)mg/L、(114.54±24.65)pg/ml、(3.54±0.15)ng/L,低于对照组的(15.24±1.47)mg/L、(148.65±24.61)pg/ml、(5.24±0.11)ng/L(P<0.05)。治疗24 h后,实验组动脉血氧分压(80.14±3.03)mm Hg、动脉血氧饱和度(94.56±1.56)%均高于对照组的(73.26±3.06)mm Hg、(87.21±1.52)%,动脉血二氧化碳分压(40.24±3.61)mm Hg低于对照组的(46.18±3.64)mm Hg(P<0.05)。治疗24 h后,实验组第1秒用力呼气容积、第1秒用力呼气容积与用力肺活量的比值、每分钟通气量分别为(1265.54±21.31)ml、(82.56±5.71)%、(7.73±0.62)L,均大于对照组的(1043.26±21.27)ml、(75.61±5.72)%、、(5.25±0.59)L(P<0.05)。实验组并发症发生率9.68%低于对照组的32.26%(P<0.05)。结论 重症支气管哮喘合并呼吸衰竭患者急诊治疗中应用无创正压通气可显著提升临床效果。

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.

膈肌超声对AECOPD撤机序贯经鼻高流量湿化氧疗和无创正压通气的评价作用

目的探讨膈肌超声对慢性阻塞性肺疾病急性加重期(AECOPD)撤机序贯经鼻高流量湿化氧疗(HFNC)和无创正压通气(NIPPV)的评价作用。方法将我院收治的40例AECOPD患者随机分为两组,A组行HFNC,B组行NIPPV治疗。采用膈肌超声评估两种治疗方式对患者膈肌功能的影响,比较两组治疗前后各时间点血流动力学变化。结果治疗后,A组吸气末膈肌厚度、呼气末膈肌厚度与膈肌增厚分数均高于B组(P<0.05)。治疗1 h、6 h、24 h、48 h后,A组的心率、MAP均低于B组(P<0.05)。结论膈肌超声可准确评估AECOPD撤机序贯HFNC和NIPPV对患者膈肌功能的改善作用,HFNC对AECOPD患者血流动力学的改善作用更加显著。

整体护理在经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的干预效果研究

目的:探讨整体护理在经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)患儿中的应用效果。方法:选择2020年10月—2021年12月于我院行NIPPV治疗的NRDS患儿60例,按随机数字表法分为两组,各30例。两组均行NIPPV治疗,对照组实施常规护理,观察组实施整体护理,对比两组治疗时间、氧合指标及并发症发生情况。结果:观察组治疗时间为(57.56±10.62)h,对照组治疗时间为(70.12±18.13)h,观察组治疗时间短于对照组,(P<0.05);观察组氧合指标中的氧分压(PaO 2)、血氧饱和度(SpO 2)水平为(83.89±6.12)mmHg、(93.94±4.92)%,均高于对照组的(70.79±5.24)mmHg、(88.87±5.02)%,二氧化碳分压(PaCO 2)水平为(41.11±4.15)mmHg,低于对照组的(47.49±4.92)mmHg,(P<0.05);与对照组相比,观察组并发症发生率(6.67%)较低,(P<0.05)。结论:整体护理在NIPPV治疗NRDS中具有较好效用,利于缩短治疗时间,改善患儿氧合情况,减少并发症的发生。

重症支气管哮喘实施无创呼吸机持续正压通气模式间断治疗的效果研究

目的分析对重症支气管哮喘患者采用无创呼吸机持续正压通气(CPAP)模式进行间断治疗的临床效果。方法74例重症支气管哮喘患者,采用随机数字表法分为观察组和对照组,每组37例。对照组患者采用常规治疗,观察组患者在对照组治疗基础上采用无创呼吸机CPAP模式间断治疗。对比两组临床疗效及治疗前后血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]、肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)以及FEV1/FVC]。结果观察组治疗总有效率为97.30%,高于对照组的83.78%,差异具有统计学意义(P<0.05)。治疗后,观察组PaO_(2)(83.69±7.95)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(94.69±5.26)%高于对照组的(76.53±8.16)mm Hg、(90.06±3.97)%,PaCO_(2)(47.95±2.06)mm Hg低于对照组的(53.16±3.86)mm Hg,差异具有统计学意义(P<0.05)。治疗后,观察组FVC(3.65±0.19)L、FEV1(2.78±0.19)L、FEV1/FVC(88.95±3.69)%高于对照组的(3.20±0.13)L、(2.55±0.17)L、(82.62±3.07)%,差异具有统计学意义(P<0.05)。结论对重症支气管哮喘患者采用无创呼吸机CPAP模式间断治疗可有效改善血气指标以及肺功能指标,并可进一步提升治疗效果。

LISA技术联合NCPAP治疗新生儿呼吸窘迫综合征的有效性分析

目的:探究经胃管注入肺表面活性物质(pulmonary surfactant,PS)治疗(LISA技术)联合新生儿持续气道正压通气(neonatal continuous positive airway pressure ventilation,NCPAP)治疗新生儿呼吸窘迫综合征的有效性。方法:选取2021年7月-2022年10月于阳江市人民医院就诊的80例符合入组标准的呼吸窘迫综合征新生儿作为本次研究对象。根据随机数表法将患儿分为对照组和研究组,各40例。研究组应用LISA技术联合NCPAP治疗,对照组应用经气管插管注入PS技术(INSURE技术)联合NCPAP治疗。比较两组治疗前后动脉血气指标、近期治疗效果及并发症发生情况。结果:两组治疗前及治疗后1 h、12 h、24 h血p H值、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))比较,差异无统计学意义(P>0.05);治疗后1 h、12 h、24 h,两组血pH值、PaO2较治疗前均升高,PaCO_(2)较治疗前均降低,差异有统计学意义(P<0.05)。研究组治疗总有效率为92.5%,高于对照组的85.0%,但两组比较差异无统计学意义(P>0.05)。研究组并发症发生率为7.5%,显著低于对照组的32.5%,差异有统计学意义(P<0.05)。结论:LISA技术联合NCPAP方案治疗新生儿呼吸窘迫综合征有良好的效果,可以有效改善血pH值、PaO_(2)及PaCO_(2)水平,降低术后并发症发生率。

终末期肺病患者肺移植术后ICU内的护理

目的总结24例终末期肺病患者肺移植术后ICU内的护理经验。方法收集2020年6月-2022年2月本中心24例终末期肺病行肺移植术后患者ICU内的临床资料,对患者术后体外膜肺氧合(ECMO)对心肺功能桥接支持的护理、心肺适应期循环管理的护理配合、移植肺正压通气呼吸支持策略及肺移植术后患者症状群护理要点进行分析总结。结果24例肺移植患者中,18例患者预后良好,3例患者术后发生并发症长期住院治疗,围手术期(术后30 d内)死亡1例,术后30 d以上因并发症死亡2例。结论在终末期肺病患者肺移植术后ICU内的护理过程中,积极开展以护士为主导的多学科团队合作管理,尤其注意密切监测患者心肺功能,并及时反馈给医疗团队,做好ECMO备用机的管理以及紧急床旁调整ECMO模式的配合工作,关注患者心肺适应期特殊循环状态的护理要点,熟悉移植肺的特点及正压通气呼吸支持策略,通过监测和不断调整为患者提供最佳的呼吸支持,同时及时评估患者可能出现的症状群并予以干预,对患者的预后至关重要。

无创正压通气和经鼻高流量氧疗治疗重症肺炎伴Ⅰ型呼吸衰竭的临床效果

目的分析无创正压通气(NIPPV)和经鼻高流量氧疗(HFNC)治疗重症肺炎(SP)伴发Ⅰ型呼吸衰竭(RF)患者的临床效果。方法选取2020年1月至2022年1月中国人民解放军联勤保障部队第九六七医院收治的60例SP伴发Ⅰ型RF患者作为研究对象,根据随机数字表法分为观察组与对比组,每组30例。对比组接受NIPPV治疗,观察组接受HFNC治疗,比较两组动脉血气指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))]、炎症反应指标[白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、痰液黏稠度、并发症发生率、住院时间、住院费用。结果治疗后,观察组PaCO_(2)及血清IL-1、TNF-α、CRP水平均低于对比组,PaO_(2)、SaO_(2)水平均高于对比组,差异有统计学意义(P<0.05)。治疗后,观察组痰液黏稠度分级优于对比组,差异有统计学意义(P<0.05)。观察组并发症发生率为0.00%,低于对比组的20.00%,差异有统计学意义(P<0.05)。观察组住院时间短于对比组,住院费用低于对比组,差异有统计学意义(P<0.05)。结论HFNC可有效改善SP伴发Ⅰ型RF患者动脉血气指标,减轻炎症反应及痰液黏稠度,降低并发症发生率。

经鼻间歇正压通气治疗早产儿呼吸窘迫综合征中实施集束化护理的干预策略

目的观察经鼻间歇正压通气治疗早产儿呼吸窘迫综合征中实施集束化护理的干预策略分析。方法选取本院(2021年1月1日—2023年6月30日)收治的早产儿呼吸窘迫综合征患儿80例,均在接受经鼻间歇正压通气治疗下,以随机数字表法分组,每组40例,其中以常规护理为对照组,以集束化护理措施为研究组。将两组患儿的血气分析结果相关指标在护理前后对比,对患儿的经鼻间歇正压通气、重症监护及住院时间进行统计,对患儿在治疗过程中出现的并发症进行统计。结果护理后的动脉血二氧化碳分压较护理前下降,研究组低于对照组,而动脉血氧饱和度、动脉血氧分压及PH值均较护理前提升,研究组高于对照组(P<0.05)。研究组患儿接受经鼻间歇正压通气时间、重症监护时间及住院时间均显著的短于对照组(P<0.05)。研究组患儿的并发症发生率低于对照组。结论通过鼻间歇正压通气治疗,在早产儿呼吸窘迫综合征下实施集束化护理,可明显改善患儿血气分析相关指标,缩短经鼻间歇正压通气治疗、重症监护和住院时间,效果较为理想,值得在临床上推广。

无创正压通气对重症支气管哮喘的疗效分析

目的探讨无创正压通气对重症支气管哮喘的临床疗效。方法以我院2011年3月-2013年8月呼吸科收治的60例重症支气管哮喘患者作为研究对象,随机分为研究组(30例)和对照组(30例)。对照组患者采用常规药物治疗,研究组在对照组基础上行无创正压通气治疗。比较两组的血气指标和临床疗效。结果两组患者年龄、性别、病程、肺功能等差异无统计学意义。两组治疗前后动脉血气指标(p H、PO_2、PCO_2、SO_2)差异均有统计学意义(P<0.05)。研究组治疗总有效率为96.7%,对照组为86.7%,差异有统计学意义(P<0.05)。结论采用无创正压通气治疗重症支气管哮喘可有效改善血气指标。

无创高频振荡通气和双水平正压通气在早产儿呼吸窘迫综合征中的临床应用效果比较研究

目的比较经鼻无创高频振荡通气(NHFOV)和双水平正压通气(DuoPAP)在早产儿呼吸窘迫综合征(RDS)中的临床应用效果。方法选取2016年6月—2017年5月新乡市中心医院新生儿重症监护病房收治的65例早产儿为研究对象,采用随机数字表法分为NHFOV组33例,DuoPAP组32例。比较两组患儿一般情况,无创呼吸支持前、无创呼吸支持后1、12、24、48、72h动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)及氧合指数(OI),72h内呼吸暂停发生率、有创呼吸支持率、无创呼吸支持时间、总用氧时间、猪肺磷脂注射液重复使用率、肺气漏、支气管肺发育不良(BPD)、新生儿坏死性小肠结肠炎(NEC)、脑室周围白质软化(PVL)发生率及死亡率。结果两组患儿性别、出生体质量、发病时间、胎龄、产前使用激素情况、猪肺磷脂注射液使用时间、剖宫产率及RDS分级比较,差异无统计学意义(P>0.05)。两组患儿PaCO_2比较,差异有统计学意义(P<0.05),PaO_2、OI比较,差异无统计学意义(P>0.05)。不同时间点PaO_2、PaCO_2及OI比较,差异有统计学意义(P<0.05)。组别和时间在PaCO_2上存在交互作用(P<0.05),组别和时间在PaO_2及OI上不存在交互作用(P>0.05)。NHFOV组呼吸暂停发生率低于DuoPAP组,差异有统计学意义(P<0.05);NHFOV组与DuoPAP组有创呼吸支持率、无创呼吸支持时间、总用氧时间、猪肺磷脂注射液重复使用率、肺气漏、BPD、NEC、PVL发生率及死亡率比较,差异无统计学意义(P>0.05)。结论在RDS的初始治疗中,NHFOV与DuoPAP相比可以更好减少CO2潴留和呼吸暂停发生率,且不增加不良反应发生率,是安全有效的通气方式。

PS联合NIPPV救治新生儿呼吸窘迫综合征的疗效观察

目的探讨肺表面活性物质(PS)联合经鼻间歇正压通气(NIPPV)救治新生儿呼吸窘迫综合征(NRDS)的疗效。方法对38例NRDS患儿进行PS联合NIPPV治疗,在治疗过程中进行精心的整体护理,并观察其疗效。结果 NIPPV与PS联合治疗能明显改善NRDS患儿心率、呼吸频率及血气分析各项指标,与治疗前比较,患儿心率、呼吸频率及PaCO2明显降低,PaO2明显升高,差异有统计学意义(P<0.05)。结论 NRDS采用PS联合NIPPV治疗能有效减少气管擦管机械通气的使用比例,对于部分可能需要气管插管的NRDS患儿,避免了因气管插管可能带来的严重并发症。