摘要
目的 探讨双水平正压通气(BiPAP)在婴幼儿左向右分流先天性心脏病合并重症肺炎心功能不全治疗中的临床效果。方法 将60例左向右分流先天性心脏病合并重症肺炎心功能不全患儿按治疗方法不同分为BiPAP治疗组(观察组)32例和常规吸氧治疗组(对照组)28例,观察2组患儿治疗前后动脉血气指标[包括氧合指数(PaO_(2)/FiO_(2))、二氧化碳分压(PaCO_(2))、乳酸(Lac)等]、呼吸频率(RR)、心率(HR)、左室射血分数(LVEF)、血清氨基末端B型利钠肽原(NT-proBNP)的变化,比较2组患儿需要机械通气比例及入住儿童重症监护室(PICU)时间。结果 观察组治疗后PaO_(2)/FiO_(2)、PaCO_(2)、Lac、RR、HR、LVEF、NT-proBNP值均较治疗前显著改善(P<0.01或P<0.001);对照组治疗后PaO_(2)/FiO_(2)、Lac、RR、NT-proBNP值均较治疗前显著改善(P<0.05或P<0.01),但对照组治疗前后PaCO_(2)、HR、LVEF值比较差异均无统计学意义(P>0.05);2组治疗后上述各指标比较.观察组均较对照组改善更为显著,差异均有统计学意义(P<0.05或P<0.001)。观察组患儿机械通气比例及入住PICU时间均较对照组显著减少(P<0.01)。结论 左向右分流先天性心脏病合并重症肺炎心功能不全患儿,早期应用BiPAP可改善临床症状及心功能,减少机械通气的比例,缩短住院时间。
Objective To evaluate the efficacy of bilevel positive airway pressure(BiPAP) in children with left-to-right shunt congenital heart disease(CHD) combined with severe pneumonia and cardiac insufficiency.Methods Sixty children with left-to-right shunt CHD complicated by severe pneumonia and cardiac insufficiency were treated with either BiPAP(observation group,32 cases) or routine oxygen inhalation(control group,28 cases).Arterial blood gas indicators(oxygenation index(PaO_(2)/FiO_(2)),PaCO_(2) and lactic acid(Lac) level),respiratory rate(RR),heart rate(HR),left ventricular ejection fraction(LVEF),and serum N-terminal pro-brain natriuretic peptide(NT-proBNP) concentration were measured before and after treatment.In addition,the proportion of children requiring mechanical ventilation and the duration of pediatric intensive care unit(PICU) stay were compared between the two groups.Results After treatment,the PaO_(2)/FiO_(2),PaCO_(2),Lac level,RR,HR,LVEF and NT-proBNP concentration were improved in the observation group,and the PaO_(2)/FiO_(2),Lac level,RR and NT-proBNP concentration were improved in the control group(P<0.05 or P<0.01).No changes in the PaCO_(2),HR and LVEF were observed in the control group after treatment(P>0.05).Compared with the control group,all these indicators were significantly meliorated in the control group(P<0.05 or P<0.001).Furthermore,compared with the control group,the proportion of children requiring mechanical ventilation and the duration of PICU stay were reduced in the control group(P<0.01).ConclusionThe early application of BiPAP can improve clinical symptoms and cardiac function,reduce the proportion of mechanical ventilation,and shorten the length of hospital stay in children with left-to-right shunt CHD complicated by severe pneumonia and cardiac insufficiency.
作者
李公利
胡苗苗
刘冉冉
杨聪聪
LI Gong-li;HU Miao-miao;LIU Ran-ran;YANG Cong-cong(Department of Pediatrics,the Second Affiliated Hospital of Shandong First Medical University,Tai’an271000,China)
出处
《实用临床医学（江西）》
CAS
2022年第4期48-51,56,共5页
Practical Clinical Medicine
关键词
双水平正压通气
先天性心脏病
重症肺炎
心功能不全
婴幼儿
bilevel positive airway pressure
congenital heart disease
severe pneumonia
cardiac insufficiency
infant
