早期持续气道正压通气治疗儿童重症肺炎并呼吸衰竭的临床疗效观察

李林祖　黄诚花　梁秀琼　何海燕　吕波　严智先

【摘要】 目的：观察对儿童重症肺炎并呼吸衰竭患者实施早期持续气道正压通气（CPAP）的临床疗效。方法：选取2015年1月-2018年1月本院收治的重症肺炎并呼吸衰竭患儿40例。按照随机数字表法将其分为观察组与对照组，各20例。对照组实施常规治疗，观察组在此基础上早期联合CPAP治疗。比较两组临床治疗效果、临床症状缓解时间，治疗前后的生命体征、血气分析指标及小儿危重症评分（PCIS）。结果：观察组总有效率高于对照组（P<0.05），临床症状缓解时间短于对照组（P<0.05）;治疗后，观察组生命体征、血气分析指标、PCIS评分均较治疗前改善，且观察组均优于对照组，差异均有统计学意义（P<0.05）。结论：对小儿重症肺炎并呼吸衰竭患者实施早期CPAP治疗，能够有效改善患者血氧状况，恢复、稳定生命体征，明显促进临床症状的恢复，且缩短了症状恢复的时间，具有理想的临床疗效及进一步推广价值。

【关键词】 小儿重症肺炎; 呼吸衰竭; 早期; 持续气道正压通气

【Abstract】Objective：To observe the clinical effect of early continuous positive airway pressure ventilation in children with severe pneumonia and respiratory failure.Method：A total of 40 children with severe pneumonia and respiratory failure admitted to our hospital from January 2015 to January 2018 were selected.According to the random number table method，they were divided into observation group and control group，20 cases in each group.The control group received routine treatment，while observation group received early CPAP treatment.The clinical efficacy，remission time of clinical symptoms，vital signs，blood gas analysis index and pediatric critical illness score（PCIS）before and after treatment between two groups were compared.Result：The total effective rate in observation group was higher than that of control group（P<0.05），and the remission time of clinical symptoms was shorter than that of control group（P<0.05）.After treatment，the vital signs，blood gas analysis index and PCIS score of observation group were improved compared with those of before treatment，and observation group were better than those of control group，the differences were statistically significant（P<0.05）.Conclusion：Early CPAP treatment for children with severe pneumonia and respiratory failure can effectively improve the blood oxygen status，restore and stabilize vital signs，significantly promote the recovery of clinical symptoms，and shorten the recovery time of symptoms，it has ideal clinical efficacy and further promotion value.

【Key words】 Severe pneumonia in children; Respiratory failure; Early stage; Continuous positive airway pressure

First-authors address：Zhaoqing First Peoples Hospital，Zhaoqing 526020，China

doi：10.3969/j.issn.1674-4985.2019.08.009

肺炎通常由病毒、細菌或支原体等外界入侵物所导致，尤其好发于呼吸系统防御功能尚未发育完全的婴幼儿，是儿科极为常见的多发性疾病。对于肺炎患儿，如不能及时有效的治疗，常会进一步发展成重症肺炎，并容易引起呼吸衰竭、心力衰竭等极严重并发症[1]。尤其并发呼吸衰竭最为常见，不仅会加重病情，造成呼吸功能障碍或严重的缺氧，更会严重威胁到患儿的生命安全。该病具有较高的发病率及致残、致死率，有报道表明，小儿重症肺炎的病死率可达20%～30%[2]。机械通气是临床上重要的辅助性通气方法，常被用于呼吸障碍、气流受限的呼吸道疾病，可以辅助改善通气及缺氧症状。其中经鼻气道正压通气更是具有操作简单方便、无创等优势，适合对年幼患者适用，是呼吸衰竭患儿的主要临床救治措施。笔者对本院部分重症肺炎合并呼吸衰竭患儿实施早期持续气道正压通气（CPAP）治疗，对比其临床疗效情况及对血氧状况的影响，现报道如下。……