双相气道
正压
通气
治疗
NRD
患儿脑氧
代谢
指标
影响
王娟
Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期treatment of bronchial asthma J.Shanxi Medical Journal,2020,49(9):99-101.吴建谷.氨茶碱联合孟鲁司特钠治疗支气管哮喘的疗效观察J.山西医药杂志,2020,49(9):99-101.10 Schuh S,Sweeney J,Rumantir M,et al.Effect of Nebulized Magne-sium vs Placebo Added to Albuterol on Hospitalization Among Chil-dren With Refractory Acute Asthma Treated in the Emergency De-partment:A Randomized Clinical Trial J.JAMA,2020,324(20):2038-2047.11 Michalik M,Wjcik-Pszczoa K,Paw M,et al.Fibroblast-to-myofi-broblast transition in bronchial asthma J.Cell Mol Life Sci,2018,75(21):3943-3961.12 Zhang XH,Chang XY.The level and clinical significance of fraction-al exhaled nitric oxide and Interleukin-8 in patients with different in-flammatory phenotypes ofcough variant asthma J.Int J Respir,2020,40(20):1585-1591.张星慧,常晓悦.IL-8与FeNO在不同炎症表型的咳嗽变异性哮喘患者中的水平及临床意义J.国际呼吸杂志,2020,40(20):1585-1591.13 Cheng D,Chen HR,Wang MM,et al.Effects of interleukin-13 onSPDEF expression in human bronchial epithelial cells and role of SP-DEF in airway mucus hypersecretion of asthma J.J Clin Inter Med,2020,37(1):53-56.程丹,陈恒睿,王梦玫,等.白细胞介素-13对人支气管上皮细胞SPDEF表达的影响及SPDEF在哮喘气道黏液高分泌中的作用J.临床内科杂志,2020,37(1):53-56.14 Nasser MZ,Ezzat DA.Association of-308G/A Polymorphism andSerum Level of TNF-with Bronchial asthma in Children J.EgyptJ Immunol,2018,25(2):117-124.15 Chen F.Effect of low-dose roxithromycin on cellular immune func-tion and inflammatory factors in children with bronchial asthma J.JXinxiang Med Coll,2020,37(1):68-71.陈芳.小剂量罗红霉素对支气管哮喘患儿细胞免疫功能及炎症因子水平的影响J.新乡医学院学报,2020,37(1):68-71.16 Nguyen-Thi-Dieu T,Le-Thi-Thu H,Duong-quy S.The profile of leu-cocytes,CD3+,CD4+,and CD8+T cells,and cytokine concentrationsin peripheral blood of children with acute asthma exacerbation J.JInt Med Res,2017,45(6):1658-1669.(收稿日期:2022-03-03)双相气道正压通气治疗NRDS的疗效及对患儿脑氧代谢指标的影响王娟1,雷娜2,亢娟1,李娟丽1,梁宽3宝鸡市人民医院感染控感科1、护理站2、儿科3,陕西宝鸡721000【摘要】目的探究双相气道正压通气治疗新生儿呼吸窘迫综合征(NRDS)的疗效及对患儿脑氧代谢指标的影响。方法选取2018年11月至2021年11月宝鸡市人民医院收治的90例NRDS患儿为研究对象,采用随机数表法分为观察组和对照组各45例,两组患儿均采用常规治疗,在此基础上对照组患儿给予持续气道正压通气法治疗,观察组患儿给予双相气道正压通气法治疗,均治疗12 h。比较两组患儿治疗12 h后的疗效,治疗前后的全身氧代谢、脑氧代谢及并发症发生情况。结果观察组患儿的治疗总有效率为97.78%,明显高于对照组的84.44%,差异有统计学意义(P0.05);治疗后,两组患者的动脉血氧分压(PaO2)、氧合指数(OI)值均升高,且观察组分别为(112.882.12)mmHg、(262.5922.31)mmHg,明显高于对照组的(100.222.23)mmHg、(223.4320.16)mmHg,二氧化碳分压(PaCO2)吸入氧浓度(FiO2)值均降低,且观察组分别为(44.141.33)mmHg、(31.237.12)%,明显低于对照组的(53.161.27)mmHg、(41.117.11)%,差异均有统计学意义(P0.05);观察组患儿治疗12 h内、治疗后5 min、治疗后10 min的脑氧饱和度(ScO2)值分别为(80.647.02)%、(84.034.17)%、(88.876.82)%,明显高于对照组的(77.477.39)%、(81.475.27)%、(83.366.97)%,差异均有统计学意义(P0.05)。观察组患儿治疗期间的并发症总发生率为4.44%,明显低于对照组的20.00%,差异有统计学意义(P0.05),具有可比性。患儿家属对试验知情并签署同意书,研究经本院伦理委员会审核通过。1.2治疗方法对照组患儿采用持续气道正压通气治疗,持续气道正压通气参数:吸入氧浓度(inspiredoxygen fraction,FiO2)30%50%,吸气峰压(peak inspi-ratory pressure,PIP)610 cmH2O(1 cmH2O=0.098 kPa),呼气末正压(positive end-expiratory pressure,PEEP)46 cmH2O,呼吸频率3040次/min。观察组患儿采用双相气道正压通气治疗,双相气道正压通气的参数设置:FIO230%50%,窥视46 cm。根据血气分析调整两组参数,维持经皮氧饱和度(oxygen saturation,SaO2)在90%95%。治疗期间对烦躁、哭闹的患儿给予镇静。所有患儿在呼吸支持时段中接受胃管内置的常规操作,胃肠减压,并酌情接受相应的对症治疗。两组均进行12 h的通气治疗。1.3观察指标(1)全身氧代谢指标监测:治疗前和治疗12 h后评估全身氧代谢指标,包括PaO2、二氧化碳分压(partial pressure of carbon dioxide,PaCO2)/FiO2、氧合指数(oxygenation index,OI)=PaO2/FiO2。(2)脑氧代谢指标监测:治疗前,通过近红外光谱监测脑氧饱和度(O2saturation,ScO2),电极放置在左前额,在PS处理前 5 min连续监测 ScO2,每5 min观察一次。统计患lected and divided into an observation group and a control group by random number table method,with 45 cases in eachgroup.On the basis of conventional treatment,neonates in the control group were treated with continuous positive air-way pressure,and those in the observation group were treated with bi-level positive airway pressure.Both groups weregiven 12 h of treatment.The two groups were compared in terms of therapeutic effects after 12 h of treatment,system-ic oxygen metabolism,and cerebral oxygen metabolism before and after treatment,and the incidence of complications.ResultsThe total treatment response rate in the observation group(97.78%)was significantly higher than that in thecontrol group(84.44%),and the difference was statistically significant(P0.05).After treatment,arterial partial pressureof oxygen(PaO2)and oxygenation index(OI)in the two groups were increased,and PaO2and OI in the observationgroup were(112.882.12)mmHg and(262.5922.31)mmHg,significantly higher than(100.222.23)mmHg and(223.4320.16)mmHg in the control group;the arterial partial pressure of carbon dioxide(PaCO2)and inspired fractionof oxygen(FiO2)were decreased,and the two in the observation group were(44.141.33)mmHg and(31.237.12)%,significantly lower than(53.161.27)mmHg and(41.117.11)%in the control group;the differences were statisticallysignificant(P0.05).The saturation of cerebral oxygen(ScO2)in the observation group within 12 h of treatment,at 5 minand 10 min after treatment were(80.647.02)%,(84.034.17)%,and(88.876.82)%,significantly higher than(77.477.39)%,(81.475.27)%,and(83.366.97)%in the control group(P0.05).The total incidence of complications in theobservation group(4.44%)was lower than that in the control group(20.00%),and the