BiPAP无创通气对先心病伴心肺功能不全的疗效评价

发布时间：2018-06-06 14:13

  本文选题：肺充血型先心病 + BiPAP　； 参考：《上海交通大学》2014年硕士论文

【摘要】：目的：对合并有心肺功能不全的肺充血型先天性心脏病患儿，早期使用BiPAP无创通气，通过观察患儿使用BiPAP前后呼吸功能及心功能的变化情况，评价早期使用BiPAP无创通气对肺充血型先心病患儿合并心肺功能不全的治疗效果及安全性。 方法：2013年12月至2014年3月入住我院PICU的肺充血型先心病伴心肺功能不全的患儿，其中17例予以BiPAP无创通气治疗，于BiPAP无创通气前、后2h、12h、24h、72h、5d、7d分别监测生命体征及血气分析，以及通气前、后5d分别进行改良Ross评分及NYU PHFI评分及监测NT-proBNP、CTnI、心彩超（Tei指数、LVEF、LVFS）指标。按照无创通气后有无换为有创通气分为无创通气成功组和失败组。回顾性统计2013年1月至2014年2月入住我院PICU的先心病患儿予无创通气或有创通气，其呼吸机相关性肺炎（VAP）的发生率。 结果：（1）BiPAP无创通气后2h起呼吸（RR）、心率（HR）及血氧饱和度（SpO2）较通气前均有明显改善，具有统计学意义（RR p=0.001；HR p=0.013；SpO2p=0.011），自BiPAP无创通气后12h起三凹征阳性率明显下降（p=0.005）。（2）BiPAP无创通气后5d与无创通气前相比，CTnI和NT proBNP明显下降（p=0.027；p=0.028），心彩超Tei指数有明显下降，其结果有统计学差异（P=0.015）；BiPAP通气前后改良Ross评分及NYU PHFI评分均有好转，有明显统计学差异（改良Ross评分p=0.000；NYU PHFI评分p=0.027）。（3）17例患儿未出现无创通气常见并发症；2013年1月至2014年2月，无创通气VAP的发病率为0%（0/37），有创通气VAP的发病率为5.62%（5/89）。 结论：（1）对伴有心肺功能不全的患儿早期使用BiPAP无创通气可有效改善患儿的呼吸功能及心功能，，成功率为76.5%。（2）Tei指数较LVEF及LVFS能更好的综合评价肺充血型先心病患儿的左心室的收缩及舒张功能。
[Abstract]:Objective: to observe the changes of respiratory function and cardiac function in children with congestive pulmonary heart disease complicated with cardiopulmonary insufficiency (BiPAP) by early use of BiPAP noninvasive ventilation. To evaluate the efficacy and safety of early use of BiPAP noninvasive ventilation in the treatment of congenital heart disease complicated with cardiopulmonary dysfunction in children with pulmonary congestive congenital heart disease. Methods: from December 2013 to March 2014, 17 children with congestive congenital heart disease and cardiopulmonary insufficiency were admitted to our hospital from December 2013 to March 2014. 17 of them were treated with BiPAP noninvasive ventilation. The vital signs and blood gas were monitored before and after 2 hours of non-invasive ventilation. Before and 5 days after ventilation, modified Ross score, NYU PHFI score and NT-proBNPN CTnI, Tei index and LVEFU LVFSs were measured respectively. According to the non-invasive ventilation, the patients were divided into two groups: the successful group and the failure group. The incidence of ventilator-associated pneumonia (VAP) in children with congenital heart disease admitted to our hospital from January 2013 to February 2014 was retrospectively analyzed. Results after 2 hours of non-invasive ventilation, RRV, HR and SPO _ 2) of BiPAP were significantly improved compared with those before ventilation. The positive rate of three concave sign from 12 hours after non-invasive ventilation of BiPAP decreased significantly. The positive rate of CTnI and NT proBNP decreased significantly 5 days after non-invasive ventilation compared with that before non-invasive ventilation, and the Tei index of cardiac color supersonic was significantly decreased, compared with that before non-invasive ventilation, the positive rate of three concave sign was significantly decreased after 12 hours of BiPAP non-invasive ventilation, compared with that before non-invasive ventilation, the positive rate of three concave sign was significantly lower than that before non-invasive ventilation, and the Tei index of cardiac color ultrasound was significantly lower than that before non-invasive ventilation, and the positive rate of CTnI and NT proBNP were significantly lower than those before and after non-invasive ventilation. The results showed that the improved Ross score and the NYU PHFI score were improved before and after ventilation, and there were significant differences (modified Ross score p0.000NPAP PHFI score p0.027NV.) there were no common complications of noninvasive ventilation in 17 children, and from January 2013 to February 2014, there were no common complications of noninvasive ventilation in 17 children with P0. 015 and 0. 015% BiPAP before and after ventilation, and there were significant differences between them from January 2013 to February 2014. The incidence of noninvasive ventilation (VAP) was 0 / 37, and the incidence of invasive ventilated VAP was 5.62 / 89. Conclusion BiPAP noninvasive ventilation can improve respiratory function and cardiac function in children with cardiopulmonary insufficiency. The success rate was that 76.5%.(2)Tei index was better than LVEF and LVFS in evaluating systolic and diastolic function of left ventricle in children with congestive congenital heart disease.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4

【参考文献】

相关期刊论文 前10条

1 陈延伟;BiPAP无创通气的临床应用[J];国外医学(呼吸系统分册);2004年01期

2 黄筱文;BiPAP呼吸机在急性左心衰竭中的临床应用[J];临床心血管病杂志;2005年10期

3 魏海燕;;先心病患儿合并呼衰心衰应用CPAP疗效观察[J];黑龙江医药;2012年04期

4 潘晔生,金立仁,魏盟,李冬青,侯晓峰,华雪蔚,顾水明;心力衰竭患者检测氨基末端脑钠素前体的意义[J];上海医学;2003年09期

5 耿荣,陈贤楠,李克华,崔威,吴冀川,钱素云,王蕾,樊寻梅;经鼻持续气道正压优先策略治疗肺血多先心病的临床研究[J];实用儿科临床杂志;2003年04期

6 李雄;阳明玉;秦静廷;张立飞;林毅;王丹;王长英;;先天性心脏病并心力衰竭患儿血浆氨基末端脑利钠肽前体水平变化的临床意义[J];实用儿科临床杂志;2012年01期

7 程蕾蕾,舒先红,韩蓓蓓,葛均波,杨成,陈灏珠;Tei指数评价冠心病患者心功能的临床研究[J];中国超声医学杂志;2003年09期

8 刘宏伟;盖鲁粤;智光;;Tei指数与有创心功能参数的相关性研究[J];中国超声医学杂志;2007年11期

9 王金祥;;正压通气时的心肺交互作用[J];中国呼吸与危重监护杂志;2006年04期

10 崔威,耿荣,金兰中,吴冀川,陈贤楠;鼻塞持续气道正压对室间隔缺损婴幼儿心肺功能的支持作用[J];中华儿科杂志;2002年11期

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