本文選題：肺充血型先心病 + BiPAP��； 參考：《上海交通大學(xué)》2014年碩士論文

【摘要】：目的：對合并有心肺功能不全的肺充血型先天性心臟病患兒，早期使用BiPAP無創(chuàng)通氣，通過觀察患兒使用BiPAP前后呼吸功能及心功能的變化情況，評價(jià)早期使用BiPAP無創(chuàng)通氣對肺充血型先心病患兒合并心肺功能不全的治療效果及安全性。 方法：2013年12月至2014年3月入住我院PICU的肺充血型先心病伴心肺功能不全的患兒，其中17例予以BiPAP無創(chuàng)通氣治療，于BiPAP無創(chuàng)通氣前、后2h、12h、24h、72h、5d、7d分別監(jiān)測生命體征及血?dú)夥治�，以及通氣前、�?d分別進(jìn)行改良Ross評分及NYU PHFI評分及監(jiān)測NT-proBNP、CTnI、心彩超（Tei指數(shù)、LVEF、LVFS）指標(biāo)。按照無創(chuàng)通氣后有無換為有創(chuàng)通氣分為無創(chuàng)通氣成功組和失敗組。回顧性統(tǒng)計(jì)2013年1月至2014年2月入住我院PICU的先心病患兒予無創(chuàng)通氣或有創(chuàng)通氣，其呼吸機(jī)相關(guān)性肺炎（VAP）的發(fā)生率。 結(jié)果：（1）BiPAP無創(chuàng)通氣后2h起呼吸（RR）、心率（HR）及血氧飽和度（SpO2）較通氣前均有明顯改善，具有統(tǒng)計(jì)學(xué)意義（RR p=0.001；HR p=0.013；SpO2p=0.011），自BiPAP無創(chuàng)通氣后12h起三凹征陽性率明顯下降（p=0.005）。（2）BiPAP無創(chuàng)通氣后5d與無創(chuàng)通氣前相比，CTnI和NT proBNP明顯下降（p=0.027；p=0.028），心彩超Tei指數(shù)有明顯下降，其結(jié)果有統(tǒng)計(jì)學(xué)差異（P=0.015）；BiPAP通氣前后改良Ross評分及NYU PHFI評分均有好轉(zhuǎn)，有明顯統(tǒng)計(jì)學(xué)差異（改良Ross評分p=0.000；NYU PHFI評分p=0.027）。（3）17例患兒未出現(xiàn)無創(chuàng)通氣常見并發(fā)癥；2013年1月至2014年2月，無創(chuàng)通氣VAP的發(fā)病率為0%（0/37），有創(chuàng)通氣VAP的發(fā)病率為5.62%（5/89）。 結(jié)論：（1）對伴有心肺功能不全的患兒早期使用BiPAP無創(chuàng)通氣可有效改善患兒的呼吸功能及心功能，，成功率為76.5%。（2）Tei指數(shù)較LVEF及LVFS能更好的綜合評價(jià)肺充血型先心病患兒的左心室的收縮及舒張功能。
[Abstract]:Objective: to observe the changes of respiratory function and cardiac function in children with congestive pulmonary heart disease complicated with cardiopulmonary insufficiency (BiPAP) by early use of BiPAP noninvasive ventilation. To evaluate the efficacy and safety of early use of BiPAP noninvasive ventilation in the treatment of congenital heart disease complicated with cardiopulmonary dysfunction in children with pulmonary congestive congenital heart disease. Methods: from December 2013 to March 2014, 17 children with congestive congenital heart disease and cardiopulmonary insufficiency were admitted to our hospital from December 2013 to March 2014. 17 of them were treated with BiPAP noninvasive ventilation. The vital signs and blood gas were monitored before and after 2 hours of non-invasive ventilation. Before and 5 days after ventilation, modified Ross score, NYU PHFI score and NT-proBNPN CTnI, Tei index and LVEFU LVFSs were measured respectively. According to the non-invasive ventilation, the patients were divided into two groups: the successful group and the failure group. The incidence of ventilator-associated pneumonia (VAP) in children with congenital heart disease admitted to our hospital from January 2013 to February 2014 was retrospectively analyzed. Results after 2 hours of non-invasive ventilation, RRV, HR and SPO _ 2) of BiPAP were significantly improved compared with those before ventilation. The positive rate of three concave sign from 12 hours after non-invasive ventilation of BiPAP decreased significantly. The positive rate of CTnI and NT proBNP decreased significantly 5 days after non-invasive ventilation compared with that before non-invasive ventilation, and the Tei index of cardiac color supersonic was significantly decreased, compared with that before non-invasive ventilation, the positive rate of three concave sign was significantly decreased after 12 hours of BiPAP non-invasive ventilation, compared with that before non-invasive ventilation, the positive rate of three concave sign was significantly lower than that before non-invasive ventilation, and the Tei index of cardiac color ultrasound was significantly lower than that before non-invasive ventilation, and the positive rate of CTnI and NT proBNP were significantly lower than those before and after non-invasive ventilation. The results showed that the improved Ross score and the NYU PHFI score were improved before and after ventilation, and there were significant differences (modified Ross score p0.000NPAP PHFI score p0.027NV.) there were no common complications of noninvasive ventilation in 17 children, and from January 2013 to February 2014, there were no common complications of noninvasive ventilation in 17 children with P0. 015 and 0. 015% BiPAP before and after ventilation, and there were significant differences between them from January 2013 to February 2014. The incidence of noninvasive ventilation (VAP) was 0 / 37, and the incidence of invasive ventilated VAP was 5.62 / 89. Conclusion BiPAP noninvasive ventilation can improve respiratory function and cardiac function in children with cardiopulmonary insufficiency. The success rate was that 76.5%.(2)Tei index was better than LVEF and LVFS in evaluating systolic and diastolic function of left ventricle in children with congestive congenital heart disease.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.4

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