危重症患儿使用NCPAP应用范围探讨及评估

发布时间：2018-03-10 07:08

  本文选题：危重症患儿　切入点：NCPAP　出处：《南华大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:目前国内外有关临床使用经鼻持续气道正压通气(Nasal Continuous Positive Airway Pressure,NCPAP)的具体应用范围仍在探讨中,本研究通过对我院PICU使用NCPAP患儿进行临床分析,明确NCPAP在儿科PICU的应用价值,初步探讨NCPAP在危重症患儿使用范围。方法:采用前瞻性研究收集2014年5月-2015年10月入住我院PICU在鼻导管给氧1小时后仍存在呼吸急促改用NCPAP的192例重症患儿临床资料,包括开始使用NCPAP时(0小时)、使用1小时后、4小时后各时间点的基本生命体征(心率、呼吸、体温、血压)、血气分析(氧分压、二氧化碳分压、PaO_2/FiO_2)指标、气促、喘息、呻吟、鼻翼煽动、三凹征及NCPAP参数(PEEP、FiO_2、气体流量)等临床资料。比较使用NCPAP前后各时间点的临床资料,评估NCPAP的临床效果。再根据使用NCPAP氧分压不同分为A组(呼吸急促组(PaO_2≥70mm Hg)),B组(呼吸急促合并氧分压减低组(50mm HgPaO_270mm Hg)),C组(呼吸急促合并呼吸衰竭组(PaO_2≤50mm Hg))三组,比较三组患儿不同时间点各项指标的变化,明确NCPAP的临床效果。比较三组使用NCPAP时长、住院时间、住PICU时间、无创辅助通气失败、出院情况,初步探讨危重症患儿使用NCPAP的应用范围。计数资料采用χ2检验,计量资料正态分布参数且方差齐时采用均数加减标准差表示,非正态分布或方差不齐,以中位数和四分位距M(P25~P75)表示,行Kruskal-wallis非参数检验,有统计学意义时行多个样本间两两比较;以p0.05,认为差异有统计学意义。结果:1.192例危重患儿中,男性119例(61.93%),女性73例(38.02%),年龄1月至6岁11月。A组56例(29.2%),B组81例(42.2%),C组55例(28.6%),三组患儿入住PICU后,24小时内PCIS评分分别为(81.14±5.16,77.11±7.11,74.73±6.38,F=14.439,p=0.001),三组比较差异有统计学意义。2、192例危重症患儿呼吸急促、心率增快、氧分压、PaO_2/FiO_2、喘息、呻吟、鼻翼煽动、三凹征使用NCPAP 0小时与使用NCPAP1小时后及使用NCPAP4小时后比较均有统计学意义(p0.05)。3、A组无创辅助通气失败2例(3.57%),B组无创通气失败9例(11.11%),C组无创通气失败30例(54.55%),A、B、C三组无创通气失败比较均有统计学意义(p0.05)。4、A、B、C三组患儿使用NCPAP时长(小时)分别为(122.57±60.83,123.82±62.71,92.18±63.25,F=2.43,p=0.042)。A、B、C三组患儿住PICU时间(天)分别为(11.77±6.94,12.14±8.45,15.60±9.64,F=3.653,p=0.028),三组患儿住院天数分别为(12.54±7.05,13.28±10.7,18.55±10.53,F=6.801,p=0.001)三组患儿使用NCPAP时长、住PICU天数、住院天数比较,A、B两组比较无统计学差异(p0.05),C组与A、B两组比较存在统计学差异(p0.05)。5、三组患儿出院情况比较,A组痊愈24例,好转32例,未愈0例;B组痊愈19例,好转53例,未愈9例;C组痊愈9例,好转31例,未愈15例,A、B、C三组出院情况比较有统计学差异(c2=25.19,p=0.001)。结论:1、NCPAP广泛用于常规吸氧仍存在呼吸异常的危重症患儿有明显疗效。2、危重症患儿出现呼吸困难时使用NCPAP可改善呼吸做功。3、鼻导管给氧下仍存在呼吸衰竭的患儿在使用NCPAP辅助通气时易导致无创辅助通气失败,使用过程中需要密切动态监测病情。
[Abstract]:Objective: to present the clinical use of nasal continuous positive airway pressure (Nasal Continuous Positive Airway Pressure, NCPAP) the specific scope of application is still in the discussion, this study analysised the clinical use of NCPAP children in our hospital PICU, clear the application value of NCPAP in pediatric PICU, preliminary study on the application range of NCPAP in the critically ill in children. Methods: a prospective study from May 2014 -2015 year in October in our hospital PICU in nasal catheter oxygen after 1 hours still exist in clinical data of 192 cases of children with severe shortness of breath with NCPAP, including start using NCPAP (0 hours), after 1 hours, the vital signs at each time point after 4 hours (heart rate, respiration, body temperature, blood pressure), blood gas analysis (PO2, pCO2, PaO_2/FiO_2 index), shortness of breath, wheezing, groaning, nose incitement, three concave syndrome and NCPAP parameters (PEEP, FiO_2, gas flow rate etc.) Compared with clinical data. Clinical data of each time point before and after NCPAP, to evaluate the clinical effect of NCPAP. According to the use of the oxygen pressure of NCPAP were divided into A group (shortness of breath group (PaO_2 = 70mm Hg)), B group (shortness of breath and oxygen pressure reduction group (50mm HgPaO_270mm Hg), C group) (shortness of breath and respiratory failure group (PaO_2 = 50mm Hg)) three groups, changes in the indicators were compared between the three groups at different time points and the clinical effect of clear NCPAP. Comparison of three groups using NCPAP time, hospitalization time, PICU stay time, noninvasive ventilation failure, a hospital, to evaluate the application scope critically ill children with NCPAP. Count data using 2 test, measurement data of normal distribution parameters and variance when using the mean and standard deviation, non normal distribution and homogeneity of variance, median and quartile range four to M (P25~P75) indicated that the Kruskal-wallis non parametric test, there are 缁熻�″�︽剰涔夋椂琛屽�氫釜鏍锋湰闂翠袱涓ゆ瘮杈�;浠�p0.05,璁や负宸�寮傛湁缁熻�″�︽剰涔�.缁撴灉:1.192渚嬪嵄閲嶆偅鍎夸腑,鐢锋，

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