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经鼻持续气道正压通气治疗5岁以下儿童社区获得性肺炎:多中心临床研究 被引量:24

Nasal continuous positive airway pressure ventilation in children with community-acquired pneumonia under five years of age: a prospective, multi-center clinical study
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摘要 目的 分析5岁以下儿童社区获得性肺炎的临床特点,探讨经鼻持续气道正压通气(NCPAP)对该患病人群治疗的有效性和安全性.方法 多中心、前瞻性临床观察性研究.以2013年11月至2015年10月全国6家儿童医院收治的符合NCPAP使用标准的29日龄~5岁社区获得性肺炎患儿为研究对象,记录其基线资料、治疗前后不同时间点动脉血气及生命体征.根据临床转归,分为治疗成功组及未成功组,比较两组患儿在基线资料、应用NCPAP治疗前及治疗后2、8及24 h的动脉氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、心率、呼吸频率、经皮氧饱和度及呼吸机条件是否存在差异;同时观察并记录与NCPAP相关的不良反应.组间比较采用x2检验、t检验或秩和检验、方差分析.结果 研究期间共有145例患儿入选,剔除数据不完整13例,最终纳入132例.其中≤12月龄患儿102例(77.3%);农村居民较多,为91例(68.9%).临床转归方面,NCPAP治疗成功组123例(93.2%);未成功组9例(6.8%),均改为气管插管有创机械通气,其中好转出院5例,死亡4例(均为放弃治疗后死亡).两组患儿在性别、年龄、体重、居住地、主要症状及阳性体征、影像学诊断和治疗前呼吸频率和心率、治疗前PaO2等方面差异均无统计学意义(P均>0.05).但治疗未成功组患儿在合并基础病、拒奶、发绀等表现上,比例明显多于成功组(P均<0.05);治疗前PaCO2明显高于成功组[(59±11)比(49±11) mmHg,1 mmHg =0.133 kPa,t=-2.597,P=0.028];治疗前PaO2/吸入氧浓度(FiO2)明显低于成功组[(150±37)比(207±63) mmHg,t=2.697,P=0.008].NCPAP治疗2、8、24 h后,成功组患儿呼吸频率、心率、PaCO2较治疗前均显著下降(P均=0.000),PaO2、PaO2/FiO2均显著上升(P均=0.000),成功组中治疗前合并高碳酸血症患儿的PaCO2均显著下降[(48±9)、(47±12)、(45±11)比(58 ±7)mmHg,P Objective To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population.Method This was a prospective multicenter study.Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications,aged from 29 d to 5 years,were continuously included during November 2013 to October 2015.The baseline data were collected and NCPAP ventilation were then followed up by operation standards,and the vital signs and arterial blood gas change at special time points were observed and recorded.Any side effect associated with NCPAP were recorded.For categorical variables,comparisons were performed using Fisher test.Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables.The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis.Result Totally 145 children were included,and 13 children were excluded due to incomplete data.One hundred and two children(77.3%)were ≤ 12 months;91 children (68.9%) were from rural area.NCPAP ventilation was effective in 123 children,with a response rate of 93.2%,were all discharged with a better condition;it was ineffective in 9 children(6.8%),and they were all intubated and went on mechanical ventilation,5 were discharged with a better condition,and 4 died after gaving up treatment.The gender,agc,body weight,residence,main symptoms,main signs,imaging diagnosis,medications,partial pressure of oxygen(PaO2),breath and heart rate before NCPAP treatment of two groups had no significant differences (all P 〉 0.05).The rates of combining underlying diseases,trouble with feeding and cyanosis,and the partial pressure of carbon dioxide (PaCO2) before NCPAP ventilation were higher in NCPAP ineffective group ((59 ± 11) vs.(49 ± 11) mmHg,1 mmHg =0.133 kPa,t =-2.597,P =0.028);whil
出处 《中华儿科杂志》 CAS CSCD 北大核心 2017年第5期329-333,共5页 Chinese Journal of Pediatrics
基金 国家科技支撑计划(2013BA109811)
关键词 连续气道正压通气 社区获得性感染 儿童 多中心研究 Continuous positive airway pressure Community-acquired infections Child Multicenter study
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