无创呼吸机辅助通气对小婴儿重症肺炎疗效的临床分析

发布时间：2018-07-09 12:07

本文选题：小婴儿 + 重症肺炎　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:通过对常规治疗与无创呼吸机辅助治疗即CPAP(持续气道正压通气Continuous Positive Airway Pressure)小婴儿重症肺炎在氧分压恢复正常时间、呼吸、心率平稳时间及喘憋缓解、Up音消失、胸片吸收好转、出院时间的比较,以了解CPAP在临床中治疗小婴儿重症肺炎中的重要作用。方法:对我院重症监护病房2014年11月至2015年2月收治的69例初发重症肺炎小婴儿进行分组,根据化验检查结果,69例患儿血白细胞、血CRP及降钙素原均有不同程度升高,痰培养结果阳性,确定为细菌感染,随机分为两组:对照组与实验组,其中对照组35例,实验组34例。治疗方法:两组患儿均给予常规治疗:头孢他啶控制感染,盐酸氨溴索雾化吸入化痰,及时吸痰加强呼吸道管理,喘息患儿予以布地奈德雾化,及保护心肝肾脏器功能等对症支持治疗。对照组予上述治疗及鼻导管吸氧或面罩吸氧,实验组予以常规治疗的同时予以无创呼吸机辅助通气代替鼻导管吸氧。监测所有患儿氧分压、呼吸、心率、喘憋、Up音、胸片等情况变化。治疗过程中有5例患儿因病情进展迅速,喘憋加重,予以气管插管,有创呼吸机控制通气,其中实验组1例,对照组4例;实验组2例患儿转上级医院治疗;实验组及对照组各有1例患儿家长因家庭经济原因放弃治疗携患儿出院,排除此9例患儿后,对照组符合条件患儿30例,实验组符合条件患儿30例。通过统计分析比较两组患儿氧分压恢复正常时间、呼吸、心率平稳时间及喘憋缓解、Up音消失、胸片恢复、出院时间的差别。应用SPSS16.0软件进行统计学分析,计量资料采用均数±标准差表示,两组间定量资料比较采用两独立样本t检验。两组间定性资料比较采用χ2检验,P0.05,差别有统计学意义。结果:1氧分压恢复正常时间:实验组[5.80±2.09小时],小于对照组[11.73±3.51小时],P0.01,差别有统计学意义。2心率平稳时间:实验组[3.03±1.06天],小于对照组[4.73±1.14天],P0.01,差别有统计学意义。3呼吸平稳时间:实验组[4.50±0.93天],小于对照组[5.87±0.86天],P0.01,差别有统计学意义。4喘憋缓解时间:实验组[4.03±0.92天],小于对照组[5.67±0.88天],P0.01,差别有统计学意义。5Up音消失时间:实验组[7.13±1.16天],小于对照组[9.00±1.43天],P0.01,差别有统计学意义。6胸片吸收好转时间:实验组[11.4±1.65天],与对照组[11.7±1.73天]相比,P㧐0.05,差别无统计学意义。7出院时间:实验组[11.67±1.66天],与对照组[12.37±1.73天]比较,P㧐0.05,差别无统计学意义。结论:CPAP治疗可缩短小婴儿重症肺炎氧分压、呼吸、心率恢复正常时间,可加快喘憋缓解及Up音吸收,减少气管插管率,在症状缓解方面有积极作用。但并不能明显加快胸片吸收速度,不能明显缩短住院时间。对治疗疗程影响不大。
[Abstract]:Objective: to study the effects of routine therapy and non-invasive ventilator therapy (CPAP) on the recovery of oxygen partial pressure (PPO), respiration, stable heart rate (HR) and dyspnea in infants with severe pneumonia during continuous positive airway pressure (CPAP). To understand the important role of CPAP in the treatment of infant severe pneumonia. Methods: 69 infants with primary severe pneumonia admitted in intensive care unit from November 2014 to February 2015 were divided into groups. According to the results of laboratory examination, 69 cases of white blood cells, serum CRP and procalcitonin were increased in varying degrees. Sputum culture results were positive, identified as bacterial infection, randomly divided into two groups: the control group and the experimental group, 35 cases in the control group, 34 cases in the experimental group. Treatment methods: two groups of children were given routine treatment: ceftazidime control infection, atomization inhalation of ambroxol hydrochloride to reduce phlegm, inhaling sputum in time to strengthen respiratory tract management, and inhaling budesonide atomization in children with wheezing. And protecting heart, liver and kidney organ function and other symptomatic support treatment. The control group was given the above treatment and nasal duct oxygen or mask oxygen inhalation, the experimental group was given routine treatment and non-invasive ventilator assisted ventilation instead of nasal duct oxygen inhalation. The changes of oxygen partial pressure, respiration, heart rate, wheezing up tone, chest radiography were monitored in all children. In the course of treatment, 5 cases were treated with tracheal intubation and ventilator controlled ventilation because of the rapid progress of the disease and the aggravation of asthma, including 1 case in the experimental group and 4 cases in the control group, and 2 cases in the experimental group were transferred to the higher hospital for treatment. One case in the experimental group and one case in the control group were discharged from hospital because of family economic reasons. After excluding the 9 cases, 30 cases in the control group and 30 cases in the experimental group were eligible. By statistical analysis, the difference of oxygen partial pressure recovery time, respiration, stable time of heart rate, the disappearance of breath relief, the recovery of chest film and the time of discharge were compared between the two groups. The statistical analysis was carried out by SPSS 16.0 software. The measurement data were expressed as mean 卤standard deviation, and the quantitative data were compared by two independent samples t test. The qualitative data of the two groups were compared by 蠂 2 test (P 0.05), and the difference was statistically significant. Results the oxygen partial pressure of the experimental group [5.80 卤2.09 hours] was smaller than that of the control group [11.73 卤3.51 hours] (P 0.01). The difference was statistically significant. 2 the stable time of heart rate in the experimental group [3.03 卤1.06 days] was lower than that in the control group [4.73 卤1.14 days] P 0.01, and the difference was statistically significant. The stable time of the experimental group [4.50 卤0.93 days] was smaller than that of the control group [5.87 卤0.86 days] (P 0.01). The difference was statistically significant (4.03 卤0.92 days), less than that of the control group [5.67 卤0.88 days] (P 0.01), and the difference was statistically significant (7.13 卤1.16 days). Compared with control group [9.00 卤1.43 days] P 0.01, the difference was statistically significant: experimental group [11.4 卤1.65 days], and control group [11.7 卤1.73 days] compared with control group [11.7 卤1.73 days], there was no significant difference in discharge time: experimental group [11.67 卤1.66 days], and control group [12.37 卤1.73 days] There was no significant difference between P0. 05 and P0. 05. Conclusion the treatment of CPAP can shorten the partial pressure of oxygen, respiration, heart rate return to normal time, can accelerate asthma relief and up tone absorption, reduce the rate of tracheal intubation, and play an active role in symptom relief. However, the absorption rate of chest radiographs could not be significantly accelerated and the hospitalization time could not be significantly shortened. It has little effect on the course of treatment.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.6

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