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目的观察在常规治疗的基础上加用无创正压通气(NIPPV)对儿童重症支气管哮喘(哮喘)的治疗作用。方法选取急性发作期重症哮喘患儿40例。随机分为NIPPV组20例和对照组20例。NIPPV组在解痉平喘、抗感染、祛痰、纠正酸碱和水电解质平衡等综合治疗基础上,于发病24 h内予NIPPV治疗;对照组除上述基础治疗外予鼻导管吸氧。监测2组治疗前及治疗4 h、8 h、12 h及24 h心率、动脉血pH、动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、血氧饱和度(SpO2)水平。结果治疗后对照组和NIPPV组心率、动脉血pH值、pa(O2)、pa(CO2)及SpO2水平均较治疗前明显改善,并且随治疗时间的延长而改善有所增加,差异均有统计学意义(Pa<0.01)。治疗后,NIPPV组较对照组改善更明显,NIPPV组在治疗4 h、8 h的心率[(119±10)次.min-1、(97±12)次.min-1]、动脉血pH(7.28±0.06、7.34±0.04)、pa(O2)[(67±6)mmHg、(81±5)mmHg](1 mmHg=0.133 kPa)、pa(CO2)[(40±9)mmHg、(31±9)mmHg]、SpO2[(96.23±1.83)%、(98.04±1.32)%]较对照组心率[(125±11)次.min-1、(104±10)次.min-1]、动脉血pH(7.22±0.08、7.29±0.07)、pa(O2)[62±6)mmHg、(76±4)mmHg]、pa(CO2)[(46±9)mmHg、(37±7)mmHg]及SpO2[(95.05±1.69)%、(97.01±1.41)%]均明显改善,差异均有统计学意义(Pa<0.05)。48 h后NIPPV组患儿全部脱机成功,且无严重并发症发生。结论早期应用NIPPV配合常规药物治疗有助于减缓重症哮喘的病情恶化,可提高急性发作的治疗效果,是抢救重症哮喘的一种安全有效的方法。
Objective To observe the therapeutic effect of noninvasive positive pressure ventilation (NIPPV) on severe bronchial asthma (asthma) in children based on routine treatment. Methods Forty children with severe asthma were selected during acute attack. 20 cases were randomly divided into NIPPV group and control group. NIPPV group was treated with NIPPV within 24 hours after onset of onset on the basis of antispasmodic and antiasthmatic effects, anti-infective, expectorant, correct acid-base and water-electrolyte balance. In the control group, nasal catheter was used for oxygen inhalation except the above basic treatment. The heart rate, arterial pH, arterial blood pressure (Pa), arterial partial pressure of carbon dioxide (PA), paO2, blood oxygen Saturation (SpO2) level. Results After treatment, heart rate, arterial blood pH, pa (O2), pa (CO2) and SpO2 in control group and NIPPV group were significantly improved compared with those before treatment, and increased with the prolongation of treatment time, with statistical differences Significance (Pa <0.01). After treatment, the NIPPV group improved more significantly than the control group. In the NIPPV group, heart rate at 4 h and 8 h [(119 ± 10) min -1, (97 ± 12) min -1], arterial blood pH (7.2 ± 0.06,7.34 ± 0.04) pa (O2) [(67 ± 6) mmHg, (81 ± 5) mmHg] (1 mmHg = 0.133 kPa) 31 ± 9) mmHg] and SpO2 [(96.23 ± 1.83)%, (98.04 ± 1.32)%] than those in the control group [(125 ± 11) min -1, (104 ± 10) min -1] , Arterial pH (7.22 ± 0.08, 7.29 ± 0.07), pa (O2) [62 ± 6] mmHg, (76 ± 4) mmHg] mmHg] and SpO2 [(95.05 ± 1.69)%, (97.01 ± 1.41)%], both of which were statistically significant (P <0.05). After 48 h, all children in the NIPPV group were successfully off-line without serious complications. Conclusion The early application of NIPPV with conventional drug therapy can help to reduce the severity of severe asthma and improve the therapeutic effect of acute attacks. It is a safe and effective method to rescue severe asthma.