经鼻双水平通气在足月儿急性呼吸窘迫综合征拔管后的应用
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摘要
目的探讨经鼻双水平正压通气模式(DuoPAP)在足月儿急性呼吸窘迫综合征拔管后应用的临床效果。方法将50例足月儿急性呼吸窘迫综合征患儿随机分为对照组及观察组,均予控制原发病,防治出血、感染,保护脏器及维持水、电解质、酸碱平衡等,达到撤机标准后予拔管,观察组在治疗好转拔管后,使用Duo PAP治疗,对照组治疗好转拔管后,使用HHFNC(高流量湿化氧疗)治疗,比较2组疗效。结果观察组经拔管予DuoPAP治疗后,无创通气时间、需要应用气管插管机械通气例数、呼吸暂停例数均较对照组减少(P均<0.05)。结论足月急性呼吸窘迫综合征患儿拔管后使用Duo PAP组较拔管后使用HHFNC组的无创通气时间减少,需再次插管上呼吸机例数减少,且发生呼吸暂停等不良反应少。
Objective To investigate the clinical effect of nasal doublelevel positive pressure ventilation (DuoPAP) after extubation in term infants with acute respiratory distress syndrome. Methods Fifty patients with acute respiratory distress syndrome were divided into control group and observation group. All patients were treated with comprehensive therapy,including the control of primary disease, prevention and treatment of bleeding, infection control, respiratory management, protection of organ function, maintenance of water, electrolytes, acid-base balance, blood sugar, blood pressure, plasma or gamma globulin support. After the weaning standard to extubation, observation group use DuoPAP after extubation, control group use of HHFNC (high-dose wet oxygen therapy) treatment. Then clinical efficacy between the two groups were compared. Results In the observation group, the number of patients with endotracheal intubation and the number of apnea were reduced compared with the control group after extubation to DuoPAP treatment (P < 0.05). Conclusion The use of DuoPAP group after extubation compared with the HHFNC group could significantly reduce the noninvasive ventilation time in the children with acute respiratory distress syndrome after extubation, need to re-intubate the ventilator to reduce the number of cases, and there were few adverse reactions such as apnea.
Objective To investigate the clinical effect of nasal doublelevel positive pressure ventilation (DuoPAP) after extubation in term infants with acute respiratory distress syndrome. Methods Fifty patients with acute respiratory distress syndrome were divided into control group and observation group. All patients were treated with comprehensive therapy,including the control of primary disease, prevention and treatment of bleeding, infection control, respiratory management, protection of organ function, maintenance of water, electrolytes, acid-base balance, blood sugar, blood pressure, plasma or gamma globulin support. After the weaning standard to extubation, observation group use DuoPAP after extubation, control group use of HHFNC (high-dose wet oxygen therapy) treatment. Then clinical efficacy between the two groups were compared. Results In the observation group, the number of patients with endotracheal intubation and the number of apnea were reduced compared with the control group after extubation to DuoPAP treatment (P < 0.05). Conclusion The use of DuoPAP group after extubation compared with the HHFNC group could significantly reduce the noninvasive ventilation time in the children with acute respiratory distress syndrome after extubation, need to re-intubate the ventilator to reduce the number of cases, and there were few adverse reactions such as apnea.
引文
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[2]宋邵华,田惠玉,杨秀芬,等.气道压力释放通气应用于急性肺损伤/急性呼吸窘迫综合征患者的研究[J].临床肺科杂志,2016,21(5):802-805.
[3]赵婷.新生儿急性呼吸窘迫综合征多因素分析[J].新疆医科大学学报,2016,39(10):1236-1238.
[4]徐明.实用儿童重症医学[M].第1版.天津科学技术出版社,2017:152-165.
[5]曹敬,孟爱宏,阎锡新.肺泡上皮细胞损伤及修复对急性肺损伤预后的影响[J].国际呼吸杂志,2014(z1):34-40.
[6]郑瑞强,翟茜,胡波,等.急性呼吸窘迫综合征有创机械通气治疗流程解析[J].中华重症医学电子杂志(网络版),2017,3(3):202-207.
[7]魏红娟,任秀伟,刘俊影,等.肺表面活性物质联合布地奈德对急性呼吸窘迫综合征极低出生体质量儿血气分析的影响[J].中国伤残医学,2015,23(18):30-31.
[8]吴健远.急性呼吸窘迫综合征的临床治疗及相关炎性因子的影响分析[J].当代医学,2014,20(2):59-60.
[9]潘健崧,陈宏香,温园香.湿化高流量鼻导管通气预防超低出生体质量儿拔管失败临床分析[J].2017,27(3):77-79.
[10]喻斌.加温湿化高流量鼻导管通气在儿科应用中的研究进展[J].中国小儿急救医学,2017,24(5):378-382.
[11]高育健,廖亮荣,江少明,等.湿化高流量鼻导管通气治疗早产儿反复发作性呼吸暂停的临床研究[J].中国新生儿科杂志,2016,31(6):433-437.
[12]戴立英,张健,王琍琍.双水平正压通气在早产儿呼吸窘迫综合征治疗中的应用[J].临床儿科杂志,2014,32(8):732-735.