本文選題：危重癥患兒　切入點：NCPAP　出處：《南華大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:目前國內(nèi)外有關(guān)臨床使用經(jīng)鼻持續(xù)氣道正壓通氣(Nasal Continuous Positive Airway Pressure,NCPAP)的具體應(yīng)用范圍仍在探討中,本研究通過對我院PICU使用NCPAP患兒進行臨床分析,明確NCPAP在兒科PICU的應(yīng)用價值,初步探討NCPAP在危重癥患兒使用范圍。方法:采用前瞻性研究收集2014年5月-2015年10月入住我院PICU在鼻導(dǎo)管給氧1小時后仍存在呼吸急促改用NCPAP的192例重癥患兒臨床資料,包括開始使用NCPAP時(0小時)、使用1小時后、4小時后各時間點的基本生命體征(心率、呼吸、體溫、血壓)、血氣分析(氧分壓、二氧化碳分壓、PaO_2/FiO_2)指標、氣促、喘息、呻吟、鼻翼煽動、三凹征及NCPAP參數(shù)(PEEP、FiO_2、氣體流量)等臨床資料。比較使用NCPAP前后各時間點的臨床資料,評估NCPAP的臨床效果。再根據(jù)使用NCPAP氧分壓不同分為A組(呼吸急促組(PaO_2≥70mm Hg)),B組(呼吸急促合并氧分壓減低組(50mm HgPaO_270mm Hg)),C組(呼吸急促合并呼吸衰竭組(PaO_2≤50mm Hg))三組,比較三組患兒不同時間點各項指標的變化,明確NCPAP的臨床效果。比較三組使用NCPAP時長、住院時間、住PICU時間、無創(chuàng)輔助通氣失敗、出院情況,初步探討危重癥患兒使用NCPAP的應(yīng)用范圍。計數(shù)資料采用χ2檢驗,計量資料正態(tài)分布參數(shù)且方差齊時采用均數(shù)加減標準差表示,非正態(tài)分布或方差不齊,以中位數(shù)和四分位距M(P25~P75)表示,行Kruskal-wallis非參數(shù)檢驗,有統(tǒng)計學(xué)意義時行多個樣本間兩兩比較;以p0.05,認為差異有統(tǒng)計學(xué)意義。結(jié)果:1.192例危重患兒中,男性119例(61.93%),女性73例(38.02%),年齡1月至6歲11月。A組56例(29.2%),B組81例(42.2%),C組55例(28.6%),三組患兒入住PICU后,24小時內(nèi)PCIS評分分別為(81.14±5.16,77.11±7.11,74.73±6.38,F=14.439,p=0.001),三組比較差異有統(tǒng)計學(xué)意義。2、192例危重癥患兒呼吸急促、心率增快、氧分壓、PaO_2/FiO_2、喘息、呻吟、鼻翼煽動、三凹征使用NCPAP 0小時與使用NCPAP1小時后及使用NCPAP4小時后比較均有統(tǒng)計學(xué)意義(p0.05)。3、A組無創(chuàng)輔助通氣失敗2例(3.57%),B組無創(chuàng)通氣失敗9例(11.11%),C組無創(chuàng)通氣失敗30例(54.55%),A、B、C三組無創(chuàng)通氣失敗比較均有統(tǒng)計學(xué)意義(p0.05)。4、A、B、C三組患兒使用NCPAP時長(小時)分別為(122.57±60.83,123.82±62.71,92.18±63.25,F=2.43,p=0.042)。A、B、C三組患兒住PICU時間(天)分別為(11.77±6.94,12.14±8.45,15.60±9.64,F=3.653,p=0.028),三組患兒住院天數(shù)分別為(12.54±7.05,13.28±10.7,18.55±10.53,F=6.801,p=0.001)三組患兒使用NCPAP時長、住PICU天數(shù)、住院天數(shù)比較,A、B兩組比較無統(tǒng)計學(xué)差異(p0.05),C組與A、B兩組比較存在統(tǒng)計學(xué)差異(p0.05)。5、三組患兒出院情況比較,A組痊愈24例,好轉(zhuǎn)32例,未愈0例;B組痊愈19例,好轉(zhuǎn)53例,未愈9例;C組痊愈9例,好轉(zhuǎn)31例,未愈15例,A、B、C三組出院情況比較有統(tǒng)計學(xué)差異(c2=25.19,p=0.001)。結(jié)論:1、NCPAP廣泛用于常規(guī)吸氧仍存在呼吸異常的危重癥患兒有明顯療效。2、危重癥患兒出現(xiàn)呼吸困難時使用NCPAP可改善呼吸做功。3、鼻導(dǎo)管給氧下仍存在呼吸衰竭的患兒在使用NCPAP輔助通氣時易導(dǎo)致無創(chuàng)輔助通氣失敗,使用過程中需要密切動態(tài)監(jiān)測病情。
[Abstract]:Objective: to present the clinical use of nasal continuous positive airway pressure (Nasal Continuous Positive Airway Pressure, NCPAP) the specific scope of application is still in the discussion, this study analysised the clinical use of NCPAP children in our hospital PICU, clear the application value of NCPAP in pediatric PICU, preliminary study on the application range of NCPAP in the critically ill in children. Methods: a prospective study from May 2014 -2015 year in October in our hospital PICU in nasal catheter oxygen after 1 hours still exist in clinical data of 192 cases of children with severe shortness of breath with NCPAP, including start using NCPAP (0 hours), after 1 hours, the vital signs at each time point after 4 hours (heart rate, respiration, body temperature, blood pressure), blood gas analysis (PO2, pCO2, PaO_2/FiO_2 index), shortness of breath, wheezing, groaning, nose incitement, three concave syndrome and NCPAP parameters (PEEP, FiO_2, gas flow rate etc.) Compared with clinical data. Clinical data of each time point before and after NCPAP, to evaluate the clinical effect of NCPAP. According to the use of the oxygen pressure of NCPAP were divided into A group (shortness of breath group (PaO_2 = 70mm Hg)), B group (shortness of breath and oxygen pressure reduction group (50mm HgPaO_270mm Hg), C group) (shortness of breath and respiratory failure group (PaO_2 = 50mm Hg)) three groups, changes in the indicators were compared between the three groups at different time points and the clinical effect of clear NCPAP. Comparison of three groups using NCPAP time, hospitalization time, PICU stay time, noninvasive ventilation failure, a hospital, to evaluate the application scope critically ill children with NCPAP. Count data using 2 test, measurement data of normal distribution parameters and variance when using the mean and standard deviation, non normal distribution and homogeneity of variance, median and quartile range four to M (P25~P75) indicated that the Kruskal-wallis non parametric test, there are 緇熻瀛︽剰涔夋椂琛屽涓牱鏈棿涓や袱姣旇緝;浠0.05,璁や負宸紓鏈夌粺璁″鎰忎箟.緇撴灉:1.192渚嬪嵄閲嶆?zhèn)ｅ効涓?鐢鋒，

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