鼻塞式持续气道正压通气治疗高原地区重症肺炎患儿效果及对血气指

论著•临床道正压通气治疗 地症肺炎患儿效果及对血 的影响邓英，唐霞，张雪琼，刘勤作者单位：626000康定，四川省甘孜藏族自治州人民医院儿科通信作者：邓英，E-mail :501205413@qq. cm【摘要】目的观察鼻塞式持续气道正压通气（CPAP)治疗高原地区重症肺炎患儿临床效果及对血气指标的影响。

方法将2014年2月一2017年2月甘孜藏族自治医院儿科收治的92例小儿重症肺炎作为研究对象，随机数字表法分为观察组和对46例。

2组患儿人院后给予综合性基础治疗，对给予面罩吸氧，观察组给予鼻塞式持续气道正压通气。

2组患者均治疗24 h。

比较2组患儿治疗前、治疗24 h后血气（Pa〇2、PaC〇2、Sa〇2)变化情况，评价临床效果，追踪患儿临床症状缓解时间及不良反应。

结果观察组总有效率为93.5%，显著高于对照组的=0.036);观察组患儿Pa02、Sa02明显高于对照组，PaC02显著低于对照组（〖=8.242、10.299、5.507, /^均=0.000);观察组呼吸困难缓解时间、发绀消失时间、心率恢复正常时间、肺啰音消失时间、胸骨凹陷消失时间及住院时间明显短于对照组（〖=7.723、7.897、5.477、6.226、5.495、4.963, ^均=0.000);组患儿在治疗过程中鼻黏膜轻微充血、瘙痒、擦伤等不良反应发生率比较，差异无统计学意义（X2=1.93、0.956、0.209, P =0.206、0.328、0.647)。

结论鼻塞式持续气道正压通气治疗高原地区重症肺炎患儿临床效果确切，能改善患儿血气指标，减轻炎性反应状态，安全性好，值得临床推广应用。

【关键词】重症肺炎;高原地区；道正压通气，鼻塞式;血气分析;小儿【D0I】10.3969 / j. issn. 1671-450.2017.11.012Mfect of nasal t ampon style continuous airway positive pressure ventilation on children witli severe pneumonia inplateau area and its effect on blood gas index D ENG Ying，TANG Xia，ZHANG Xueqiong，LIU Qin. Department of tries, Garni Tibetan Autonomous Prefecture People s Hospital, K angding 626000，ChinaCorresponding author：DENG Ying，E-mail：501205413@c o m【A bstract】Objective To investigate the effect of nasal tampon style continuous airway positive pressure ventilationon children with severe pneumonia in plateau area and its effect on blood gas index. Methods Ninety-two cases of childrenwith severe pneumonia in plateau area were selected, which were treated in department of pediatrics mous Prefecture People s Hospital f rom February 2014 to February 2017，and they were divided into the observation group (46cases) and control group (46 cases). The patients of two groups were all treated with comprehensive basic treatment after ad­mission. The patients of control group were treated with mask o xygen，while the patients of observation group were tre nasal tampon style continuous airway positive pressure ventilation. The patients of two groups were all treated fo row. Compare the clinical symptoms remission time，clinical effect，safety and changes of the Pa two groups before and after treatment for 24 hours. Results The patients of the observation group got a total effective rate of93.5%，which was significantly better than the 78. 3% of the control group (X= 4. 389; P = 0. 036) ; The Pa02，Sa02levels of the observation group were significantly higher than those of the control group, and the PaC02 levels of the observationgroup were significantly lower than those of the control group (=8. 242，= 10. 299，= 5. 507 ; P = 0. 000，P = 0. 000，P =0. 000) ；The d yspnea time, cyanosis disappearance time, heart rate returned to normal time, lung rales disappear time，ster­nal sag disappearance time a nd length of stay of the observation group were significantly lower than those of the control group(t = 7.723，t = 7.897，t = 5.477，t = 6.226，t = 5.495，t = 4.963; P=0.000，P= 0.000，P= 0.000，P= 0.000，P =0. 000，P = 0. 000) ; There were nasal mucosa slightly congested，itching，wiping pain and other adverse reactions occurred inboth two groups，but there were no statistically significant between the two groups ( X= 1.593，0. 956，0. .09，P >0. 05 ).Conclusion The clinical effect of nasal tampon style continuous airway positive pressure ventilation in the treatment of chil­dren with severe pneumonia in the plateau area is exact. It can improve the child's blood gas i nd state, and also has a high safety, which makes it worthy of clinical application.[Keywords】Severe pneumonia; Plateau area；Continuous airway positive pressure ventilation；Nasal tampon style；Blood gas analysis;Children肺炎是小儿常见的呼吸系统疾病之一，小儿由于 免疫功能和全身器官尚未发育成熟，呼吸道上皮组织 分泌型免疫球蛋白A分泌不足，黏膜抵抗力降低，咳 嗽、咯痰能力相对较弱，吞咽反射较差，极易引发反流，从而进展为重症肺炎[1]。

尤其处于高原地区，气候干 燥、寒冷多变、昼夜温差较大等原因，致使呼吸系统感 染几率增高，并发症多，常累及全身器官，导致病情恶 化，病程进展迅速，甚至死亡[2]。

临床资料显示[]，高 原地区小儿重症肺炎发病率明显高于平原地区，将近 占全年住院总数的43%。

重症肺炎患儿在病原微生 物作用下，其肺泡气体交换有效面积急剧减少，患儿出 现缺氧、呼吸障碍等一系列症状，需要及时给予呼吸、循环支持手段治疗。

临床通常采用经鼻导管高流量给 氧或机械通气治疗小儿重症肺炎，但经鼻导管高流量 给氧对肺功能残气量及降低肺顺应性效果不佳;而机 械通气因建立人工气道增大机械性损伤，增加相关并 发症发生[4]。

持续气道正压通气是在呼气末肺泡仍 继续处于正压，使得萎缩肺泡膨胀、扩张，能改善肺功 能残气量，控制肺内体液渗出，缓解肺间质水肿损伤。

鉴于此，本研究通过应用持续气道正压通气（CPAP)治疗高原地区小儿重症肺炎，观察其临床效果及对血 气指标的影响，现将结果报道如下。

1资料与方法1.1临床资料将2014年2月一2017年2月甘孜藏 族自治州人民医院儿科收治的92例小儿重症肺炎作 为研究对象，按照随机数字表法分为观察组和对照组 各46例。

观察组男25例，女21例，年龄1 ~4(3. 2 ± 0.5)岁;生活环境海拔高度：<1 000 m 6例，1 000 ~ 2 600 m9 例，>2 600 ~3 500 m 13 例，>3 500 m 18 例;病程10 h~5 d，平均(51.4±15.8)h;合并症:呼吸 衰竭32例，心力衰竭21例。

对照组男23例，女23 例，年龄1 ~5(3. 1 ±0. 8)岁；生活环境海拔高度：< 1 000 m8 例，> 1 000 ~ 2 600 m 12 例，> 2 600 ~ 3 500 m l1 例，>3 500 m 15 例;病程 12 h~5 d，平均 (53.2 ±14.3)h;合并症：呼吸衰竭34例，心力衰竭2例。