加溫濕化高流量鼻導管通氣治療重癥肺炎的臨床療效觀察與研究

蔡燕鴻 曾振華 曹曉燕

【摘要】 目的 探討加溫濕化高流量鼻導管通氣（HHFNC）治療重癥肺炎的臨床療效與實用價值。方法 60例重癥肺炎患兒， 隨機分為治療組與對照組， 每組30例， 在研究過程中， 治療組無患兒退出， 對照組因各種原因退出3例患兒， 研究結束時對照組27例， 治療組30例。治療組按兒科常規護理治療， 同時給予加溫濕化高流量鼻導管通氣治療；對照組按兒科常規護理治療， 并予常規氧療。比較兩組的治療效果。結果 治療前兩組小兒危重病例評分法（PCIS）評分及氧分壓比較差異均無統計學意義（P>0.05）；治療后12～24 h治療組氧分壓高于對照組， 差異具有統計學意義（P<0.05）。治療后12～24 h， 治療組總有效率80.0%高于對照組的55.6%， 差異具有統計學意義（P<0.05）。治療組呼吸困難緩解天數、心率恢復正常天數及住院治療天數均短于對照組， 差異均具有統計學意義（P<0.05）。結論 加溫濕化高流量鼻導管通氣治療重癥肺炎的臨床療效顯著， 有舒適、安全、易于操作、療效顯著四大實用價值， 值得臨床推廣。

【關鍵詞】 加溫濕化高流量鼻導管通氣；重癥肺炎；臨床療效

DOI：10.14163/j.cnki.11-5547/r.2018.10.002

【Abstract】 Objective To discuss the clinical efficacy and practical value of humidified high flow nasal cannula （HHFNC） in the treatment of severe pneumonia. Methods A total of 60 severe pneumonia children were randomly divided into treatment group and control group， with 30 cases in each group. During the study， no children were withdrawn from the treatment group， and 3 children withdrew from the control group for various reasons. There were 27 cases in the control group and 30 cases in the treatment group at the end of the study. The treatment group received conventional nursing and humidified high flow nasal cannula for treatment， and the control group received conventional nursing and conventional oxygen therapy. The treatment effect in two groups was compared. Results Before treatment， both groups had no statistically significant difference in pediatric critical illness scale （PCIS） score and oxygen partial pressure （P>0.05）. After 12～24 h of treatment， the treatment group had higher oxygen partial pressure than the control group， and the difference was statistically significant （P<0.05）. After 12～24 h of treatment， the treatment group had higher total effective rate as 80.0% than 55.6% in the control group， and the difference was statistically significant （P<0.05）. The treatment group had shorter dyspnea remission time， heart rate back to normal time and hospitalization time than the control group， and their difference was statistically significant （P<0.05）. Conclusion Humidified high flow nasal cannula shows remarkable clinical efficacy in treating severe pneumonia with four practical vale of comfort， safety， easy operation and remarkable efficacy， and it is worthy of clinical promotion.

【Key words】 Humidified high flow nasal cannula； Severe pneumonia； Clinical efficacy

小兒肺炎為兒科的常見病、多發病， 病死率居我國兒科住院疾病首位， 是5歲以下兒童死亡的主要原因， 死亡病例主要為重癥肺炎[1]， 呼吸衰竭是重癥肺炎患兒死亡的主要原因[2]， 故氧療成為治療重癥肺炎重要環節。氧療可通過有創與無創呼吸支持實現， 本研究以無創氧療為研究方向。加溫濕化高流量鼻導管通氣是本次研究的主要研究方式， 通過臨床實際運用分析其在治療重癥肺炎中的療效及實用性。現報告如下。