本文選題：小嬰兒 + 重癥肺炎　； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:通過對常規(guī)治療與無創(chuàng)呼吸機輔助治療即CPAP(持續(xù)氣道正壓通氣Continuous Positive Airway Pressure)小嬰兒重癥肺炎在氧分壓恢復(fù)正常時間、呼吸、心率平穩(wěn)時間及喘憋緩解、Up音消失、胸片吸收好轉(zhuǎn)、出院時間的比較,以了解CPAP在臨床中治療小嬰兒重癥肺炎中的重要作用。方法:對我院重癥監(jiān)護(hù)病房2014年11月至2015年2月收治的69例初發(fā)重癥肺炎小嬰兒進(jìn)行分組,根據(jù)化驗檢查結(jié)果,69例患兒血白細(xì)胞、血CRP及降鈣素原均有不同程度升高,痰培養(yǎng)結(jié)果陽性,確定為細(xì)菌感染,隨機分為兩組:對照組與實驗組,其中對照組35例,實驗組34例。治療方法:兩組患兒均給予常規(guī)治療:頭孢他啶控制感染,鹽酸氨溴索霧化吸入化痰,及時吸痰加強呼吸道管理,喘息患兒予以布地奈德霧化,及保護(hù)心肝腎臟器功能等對癥支持治療。對照組予上述治療及鼻導(dǎo)管吸氧或面罩吸氧,實驗組予以常規(guī)治療的同時予以無創(chuàng)呼吸機輔助通氣代替鼻導(dǎo)管吸氧。監(jiān)測所有患兒氧分壓、呼吸、心率、喘憋、Up音、胸片等情況變化。治療過程中有5例患兒因病情進(jìn)展迅速,喘憋加重,予以氣管插管,有創(chuàng)呼吸機控制通氣,其中實驗組1例,對照組4例;實驗組2例患兒轉(zhuǎn)上級醫(yī)院治療;實驗組及對照組各有1例患兒家長因家庭經(jīng)濟原因放棄治療攜患兒出院,排除此9例患兒后,對照組符合條件患兒30例,實驗組符合條件患兒30例。通過統(tǒng)計分析比較兩組患兒氧分壓恢復(fù)正常時間、呼吸、心率平穩(wěn)時間及喘憋緩解、Up音消失、胸片恢復(fù)、出院時間的差別。應(yīng)用SPSS16.0軟件進(jìn)行統(tǒng)計學(xué)分析,計量資料采用均數(shù)±標(biāo)準(zhǔn)差表示,兩組間定量資料比較采用兩獨立樣本t檢驗。兩組間定性資料比較采用χ2檢驗,P0.05,差別有統(tǒng)計學(xué)意義。結(jié)果:1氧分壓恢復(fù)正常時間:實驗組[5.80±2.09小時],小于對照組[11.73±3.51小時],P0.01,差別有統(tǒng)計學(xué)意義。2心率平穩(wěn)時間:實驗組[3.03±1.06天],小于對照組[4.73±1.14天],P0.01,差別有統(tǒng)計學(xué)意義。3呼吸平穩(wěn)時間:實驗組[4.50±0.93天],小于對照組[5.87±0.86天],P0.01,差別有統(tǒng)計學(xué)意義。4喘憋緩解時間:實驗組[4.03±0.92天],小于對照組[5.67±0.88天],P0.01,差別有統(tǒng)計學(xué)意義。5Up音消失時間:實驗組[7.13±1.16天],小于對照組[9.00±1.43天],P0.01,差別有統(tǒng)計學(xué)意義。6胸片吸收好轉(zhuǎn)時間:實驗組[11.4±1.65天],與對照組[11.7±1.73天]相比,P㧐0.05,差別無統(tǒng)計學(xué)意義。7出院時間:實驗組[11.67±1.66天],與對照組[12.37±1.73天]比較,P㧐0.05,差別無統(tǒng)計學(xué)意義。結(jié)論:CPAP治療可縮短小嬰兒重癥肺炎氧分壓、呼吸、心率恢復(fù)正常時間,可加快喘憋緩解及Up音吸收,減少氣管插管率,在癥狀緩解方面有積極作用。但并不能明顯加快胸片吸收速度,不能明顯縮短住院時間。對治療療程影響不大。
[Abstract]:Objective: to study the effects of routine therapy and non-invasive ventilator therapy (CPAP) on the recovery of oxygen partial pressure (PPO), respiration, stable heart rate (HR) and dyspnea in infants with severe pneumonia during continuous positive airway pressure (CPAP). To understand the important role of CPAP in the treatment of infant severe pneumonia. Methods: 69 infants with primary severe pneumonia admitted in intensive care unit from November 2014 to February 2015 were divided into groups. According to the results of laboratory examination, 69 cases of white blood cells, serum CRP and procalcitonin were increased in varying degrees. Sputum culture results were positive, identified as bacterial infection, randomly divided into two groups: the control group and the experimental group, 35 cases in the control group, 34 cases in the experimental group. Treatment methods: two groups of children were given routine treatment: ceftazidime control infection, atomization inhalation of ambroxol hydrochloride to reduce phlegm, inhaling sputum in time to strengthen respiratory tract management, and inhaling budesonide atomization in children with wheezing. And protecting heart, liver and kidney organ function and other symptomatic support treatment. The control group was given the above treatment and nasal duct oxygen or mask oxygen inhalation, the experimental group was given routine treatment and non-invasive ventilator assisted ventilation instead of nasal duct oxygen inhalation. The changes of oxygen partial pressure, respiration, heart rate, wheezing up tone, chest radiography were monitored in all children. In the course of treatment, 5 cases were treated with tracheal intubation and ventilator controlled ventilation because of the rapid progress of the disease and the aggravation of asthma, including 1 case in the experimental group and 4 cases in the control group, and 2 cases in the experimental group were transferred to the higher hospital for treatment. One case in the experimental group and one case in the control group were discharged from hospital because of family economic reasons. After excluding the 9 cases, 30 cases in the control group and 30 cases in the experimental group were eligible. By statistical analysis, the difference of oxygen partial pressure recovery time, respiration, stable time of heart rate, the disappearance of breath relief, the recovery of chest film and the time of discharge were compared between the two groups. The statistical analysis was carried out by SPSS 16.0 software. The measurement data were expressed as mean 鹵standard deviation, and the quantitative data were compared by two independent samples t test. The qualitative data of the two groups were compared by 蠂 2 test (P 0.05), and the difference was statistically significant. Results the oxygen partial pressure of the experimental group [5.80 鹵2.09 hours] was smaller than that of the control group [11.73 鹵3.51 hours] (P 0.01). The difference was statistically significant. 2 the stable time of heart rate in the experimental group [3.03 鹵1.06 days] was lower than that in the control group [4.73 鹵1.14 days] P 0.01, and the difference was statistically significant. The stable time of the experimental group [4.50 鹵0.93 days] was smaller than that of the control group [5.87 鹵0.86 days] (P 0.01). The difference was statistically significant (4.03 鹵0.92 days), less than that of the control group [5.67 鹵0.88 days] (P 0.01), and the difference was statistically significant (7.13 鹵1.16 days). Compared with control group [9.00 鹵1.43 days] P 0.01, the difference was statistically significant: experimental group [11.4 鹵1.65 days], and control group [11.7 鹵1.73 days] compared with control group [11.7 鹵1.73 days], there was no significant difference in discharge time: experimental group [11.67 鹵1.66 days], and control group [12.37 鹵1.73 days] There was no significant difference between P0. 05 and P0. 05. Conclusion the treatment of CPAP can shorten the partial pressure of oxygen, respiration, heart rate return to normal time, can accelerate asthma relief and up tone absorption, reduce the rate of tracheal intubation, and play an active role in symptom relief. However, the absorption rate of chest radiographs could not be significantly accelerated and the hospitalization time could not be significantly shortened. It has little effect on the course of treatment.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R725.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 沈宏波;;無創(chuàng)呼吸機在急性心力衰竭合并呼吸衰竭救治中的應(yīng)用價值[J];中外醫(yī)療;2014年23期

2 李軍利;常雙喜;孟鵬飛;李艷麗;閆圣杰;;無創(chuàng)正壓通氣在呼吸衰竭合并左心衰竭患者有創(chuàng)機械通氣撤機中的應(yīng)用[J];醫(yī)藥論壇雜志;2014年07期

3 馮曉玲;王麗平;朱建平;胡茜;劉麗華;武凱;;無創(chuàng)機械通氣治療老年COPD合并呼吸衰竭的療效分析[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2014年10期

4 賴建幸;陳小會;;無創(chuàng)正壓通氣治療慢性阻塞性肺疾病急性加重期呼吸衰竭的臨床研究[J];中國現(xiàn)代醫(yī)生;2014年04期

5 唐秋靜;;無創(chuàng)正壓通氣并經(jīng)管道霧化吸入可必特治療重癥支氣管哮喘的臨床研究[J];中外醫(yī)學(xué)研究;2013年29期

6 張振坤;李衛(wèi)華;姜朕;朱峰;魏海燕;;小兒呼吸機相關(guān)性肺炎54例臨床特點及病原菌分析[J];兒科藥學(xué)雜志;2012年09期

7 劉苗苗;孫鳳皇;;不同機械通氣方式對慢性阻塞性肺疾病(COPD)呼吸衰竭患者的治療結(jié)果[J];現(xiàn)代診斷與治療;2012年06期

8 丁凌;;呼吸機相關(guān)肺炎的危險因素調(diào)查分析[J];中國現(xiàn)代醫(yī)生;2012年18期

9 鐘玲;;重癥哮喘急救中應(yīng)用機械通氣的療效分析[J];中國醫(yī)學(xué)創(chuàng)新;2011年18期

10 成驄;趙偉;姚文虎;趙紅;;麻疹并發(fā)重癥肺炎35例臨床分析[J];現(xiàn)代醫(yī)學(xué);2009年05期

，

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