中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
6期
424-427
,共4页
孙印兰%李敏%于永慧%陈娜%孙正芸
孫印蘭%李敏%于永慧%陳娜%孫正蕓
손인란%리민%우영혜%진나%손정예
先天性心脏病%肺动脉高压%充血性心力衰竭%持续呼吸道正压通气
先天性心髒病%肺動脈高壓%充血性心力衰竭%持續呼吸道正壓通氣
선천성심장병%폐동맥고압%충혈성심력쇠갈%지속호흡도정압통기
Congenital heart disease%Pulmonary artery hypertension%Congestive heart failure%Continuous positive airway pressure ventilation
目的 探讨发生急性充血性心力衰竭(CHF)的先天性心脏病(CHD)并肺动脉高压(PH)婴儿早期应用鼻塞持续呼吸道正压通气(nCPAP)对其CHF急性期症状和预后的影响.方法 发生急性CHF的CHD患儿60例,随机分为nCPAP组(n=32)和非nCPAP组(n=28).nCPAP组入院后即给予nCPAP无创呼吸支持,非nCPAP组给予鼻导管吸氧,分别在nCPAP治疗开始时、治疗1d和治疗3～7d撤离nCPAP/气管插管机械通气前分别进行动脉血气分析测定乳酸值(Lac)、计算氧合指数[Pa(O2)/FiO2],检测血清氨基末端B型脑钠肽前体(NT-proBNP)水平,无创超声心动图(UCG)测定左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)、肺动脉收缩压(PASP).分别比较2组患儿治疗前后及治疗后2组患儿间动脉血气、血清NT-proBNP水平及心功能改善情况,以及2组患儿需要机械通气的比例、机械通气时间、入住PICU的时间和病死率等临床预后的差异.结果 1.治疗前后动脉血气比较:治疗1d,nCPAP组患儿a(O2)/FiO2、Lac与非nCPAP组相比,差异均有统计学意义(t=4.743、5.402,P均＜0.05);治疗3～7d,nCPAP组pa(O2)/FiO2与非nCPAP组比较差异有统计学意义(t=6.366,P＜0.05),Lac水平与非nCPAP组比较差异无统计学意义(t=1.812,P＞0.05).2.治疗前后UCG心功能比较:治疗3～7 d,nCPAP组患儿LVEDVI、LVEF、PASP与非nCPAP组比较差异均有统计学意义(t=2.052、2.704、2.019,P均＜0.05).3.治疗前后血清学指标比较:治疗3～7d,nCPAP组患儿NT-proBNP明显低于非nCPAP组,差异有统计学意义(=9.869,P＜0.05).4.临床预后比较:治疗后2组患儿需行气管插管机械通气的比例、机械通气的时间、入住PICU的时间及病死率亦存在明显差异(x2=5.505,P=0.019;t =4.788,P=0.000;t=5.068,P=0.000;x2=4.284,P=0.038).结论 存在PH的CHD患儿发生急性CHF时,尽早给予无创nCPAP支持可改善氧合,通过降低左心室/右心室后负荷,改善左心室功能,降低插管率和短期病死率,改善预后.
目的 探討髮生急性充血性心力衰竭(CHF)的先天性心髒病(CHD)併肺動脈高壓(PH)嬰兒早期應用鼻塞持續呼吸道正壓通氣(nCPAP)對其CHF急性期癥狀和預後的影響.方法 髮生急性CHF的CHD患兒60例,隨機分為nCPAP組(n=32)和非nCPAP組(n=28).nCPAP組入院後即給予nCPAP無創呼吸支持,非nCPAP組給予鼻導管吸氧,分彆在nCPAP治療開始時、治療1d和治療3～7d撤離nCPAP/氣管插管機械通氣前分彆進行動脈血氣分析測定乳痠值(Lac)、計算氧閤指數[Pa(O2)/FiO2],檢測血清氨基末耑B型腦鈉肽前體(NT-proBNP)水平,無創超聲心動圖(UCG)測定左心室舒張末期容積指數(LVEDVI)、左心室射血分數(LVEF)、肺動脈收縮壓(PASP).分彆比較2組患兒治療前後及治療後2組患兒間動脈血氣、血清NT-proBNP水平及心功能改善情況,以及2組患兒需要機械通氣的比例、機械通氣時間、入住PICU的時間和病死率等臨床預後的差異.結果 1.治療前後動脈血氣比較:治療1d,nCPAP組患兒a(O2)/FiO2、Lac與非nCPAP組相比,差異均有統計學意義(t=4.743、5.402,P均＜0.05);治療3～7d,nCPAP組pa(O2)/FiO2與非nCPAP組比較差異有統計學意義(t=6.366,P＜0.05),Lac水平與非nCPAP組比較差異無統計學意義(t=1.812,P＞0.05).2.治療前後UCG心功能比較:治療3～7 d,nCPAP組患兒LVEDVI、LVEF、PASP與非nCPAP組比較差異均有統計學意義(t=2.052、2.704、2.019,P均＜0.05).3.治療前後血清學指標比較:治療3～7d,nCPAP組患兒NT-proBNP明顯低于非nCPAP組,差異有統計學意義(=9.869,P＜0.05).4.臨床預後比較:治療後2組患兒需行氣管插管機械通氣的比例、機械通氣的時間、入住PICU的時間及病死率亦存在明顯差異(x2=5.505,P=0.019;t =4.788,P=0.000;t=5.068,P=0.000;x2=4.284,P=0.038).結論 存在PH的CHD患兒髮生急性CHF時,儘早給予無創nCPAP支持可改善氧閤,通過降低左心室/右心室後負荷,改善左心室功能,降低插管率和短期病死率,改善預後.
목적 탐토발생급성충혈성심력쇠갈(CHF)적선천성심장병(CHD)병폐동맥고압(PH)영인조기응용비새지속호흡도정압통기(nCPAP)대기CHF급성기증상화예후적영향.방법 발생급성CHF적CHD환인60례,수궤분위nCPAP조(n=32)화비nCPAP조(n=28).nCPAP조입원후즉급여nCPAP무창호흡지지,비nCPAP조급여비도관흡양,분별재nCPAP치료개시시、치료1d화치료3～7d철리nCPAP/기관삽관궤계통기전분별진행동맥혈기분석측정유산치(Lac)、계산양합지수[Pa(O2)/FiO2],검측혈청안기말단B형뇌납태전체(NT-proBNP)수평,무창초성심동도(UCG)측정좌심실서장말기용적지수(LVEDVI)、좌심실사혈분수(LVEF)、폐동맥수축압(PASP).분별비교2조환인치료전후급치료후2조환인간동맥혈기、혈청NT-proBNP수평급심공능개선정황,이급2조환인수요궤계통기적비례、궤계통기시간、입주PICU적시간화병사솔등림상예후적차이.결과 1.치료전후동맥혈기비교:치료1d,nCPAP조환인a(O2)/FiO2、Lac여비nCPAP조상비,차이균유통계학의의(t=4.743、5.402,P균＜0.05);치료3～7d,nCPAP조pa(O2)/FiO2여비nCPAP조비교차이유통계학의의(t=6.366,P＜0.05),Lac수평여비nCPAP조비교차이무통계학의의(t=1.812,P＞0.05).2.치료전후UCG심공능비교:치료3～7 d,nCPAP조환인LVEDVI、LVEF、PASP여비nCPAP조비교차이균유통계학의의(t=2.052、2.704、2.019,P균＜0.05).3.치료전후혈청학지표비교:치료3～7d,nCPAP조환인NT-proBNP명현저우비nCPAP조,차이유통계학의의(=9.869,P＜0.05).4.림상예후비교:치료후2조환인수행기관삽관궤계통기적비례、궤계통기적시간、입주PICU적시간급병사솔역존재명현차이(x2=5.505,P=0.019;t =4.788,P=0.000;t=5.068,P=0.000;x2=4.284,P=0.038).결론 존재PH적CHD환인발생급성CHF시,진조급여무창nCPAP지지가개선양합,통과강저좌심실/우심실후부하,개선좌심실공능,강저삽관솔화단기병사솔,개선예후.
Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH).Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n =32) and the non-nCPAP group (n =28).Data were analyzed,which included lactic acid value (Lac) by arterial blood gas analysis,calculation of oxygenation index [pa (O2)/FiO2],detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level,determination of left ventricular end diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG).Results 1.Comparison of arterial blood gas between the 2 groups:1 d after treatment,there were significant differences in pa (O2)/FiO2 and Lac between the 2 groups (t =4.743,5.402,all P ＜ 0.05).A significant difference was found in the pa (O2)/FiO2 between the nCPAP group and the non-nCPAP group 3-7 d after treatment(t =6.366,P ＜ 0.05).The level of Lac had no significant difference between the 2 groups 3-7 d after treatment(t =1.812,P ＞ 0.05).2.Comparison of index of heart function between the 2 groups:after 3-7 d treatment,LVEDVI,LVEF,and PASP were statistically different between the 2 groups (t =2.052,2.704,2.019,all P ＜0.05).3.Comparison of serum indexes between the 2 groups:3-7 d after treatment,serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t =9.869,P ＜0.05).4.Comparison of clinical prognosis between the 2 groups:the differences in needing endobronchial intubation rate,mechanical ventilation time,time in PICU and mortality rate were all statistically significant between the 2 groups (x2 =5.505,P =0.019; t =4.788,P =0.000;t =5.068,P =0.000 ;x2 =4.284 ;P =0.038).Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa (O2)/FiO2,reducing left ventricular and right ventricular afterload and improving the left ventricular function.
