呼吸机无创高频振荡通气在极低出生体质量儿呼吸窘迫综合征 42例中的疗效分析

目的 探讨无创高频振荡通气在极低出生体质量儿呼吸窘迫综合征拔管撤机后的效果.方法 选择2017年3月至2019年2月在四川省妇幼保健院接受有创呼吸支持超48 h,并在出生3周内撤机的极低出生体质量呼吸窘迫综合征病儿85例进行回顾性分析.根据接受呼吸支持的不同将其分为两组,对照组43例行经鼻持续气道正压通气(NCPAP),观察组42例行经鼻无创高频振荡通气模式(NHFOV).对比两组7 d内撤机成功率、血气分析指标、一般情况、并发症发生情况.结果 观察组7 d内撤机成功率为83.72％,明显高于对照组的65.12％(P<0.05).两组二氧化碳分压(PaCO2)水平均明显下降,但观察组下降幅度更大,两组氧分压(PaO2)及氧分压/吸氧分数(FiO2)水平均明显升高,但观察组升高更明显(P<0.05).两组总辅助通气时间对比差异无统计学意义(P>0.05),但观察组开奶时间及全肠喂养时间均明显较对照组短(P<0.05).对照组共出现14例(33.33％)并发症,与观察组出现5例(11.63％)对比差异有统计学意义(P<0.05).结论 NHFOV较NCPAP可明显提高极低出生体质量儿呼吸窘迫综合征拔管撤机成功率,改善病儿血气分析指标,缩短开奶时间及全肠喂养时间,降低并发症发生率.     

Establishment of a nomogram model for the early diagnosis of childhood sepsis北大核心CSCD

Objective To establish a nomogram model for the early diagnosis of sepsis in children. Methods A total of 76 children with sepsis who were admitted to Sichuan Maternal and Child Health Hospital from January 2018 to June 2021 were retrospectively selected as the sepsis group. After matching for sex and age (±2 years) at a ratio of 1:1:1, 76 children with local infection who were hospitalized during the same period were enrolled as the local infection group, and 76 children with non-infectious diseases were enrolled as the control group. The three groups were compared in terms of laboratory markers and the results of quick Sequential Organ Failure Assessment (qSOFA) and Pediatric Critical Illness Score (PCIS). A multivariate logistic regression analysis was used to investigate the association between the above indicators and sepsis. R4.1.3 software was used to establish and validate the nomogram model for the early diagnosis of sepsis based on the results of the multivariate analysis. A receiver operating characteristic (ROC) curve analysis was used to evaluate the value of the nomogram model, and the Bootstrap method was used to perform the internal validation of the model. Results The multivariate logistic regression analysis showed that soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 were independently associated with childhood sepsis (P<0.05). The above indicators were used to establish a nomogram for the early diagnosis of sepsis, with an area under the ROC curve of 0.837 (95%CI: 0.760-0.914), and the calibration curve results showed a mean absolute error of 0.024, suggesting that the performance of this model was basically consistent with that of the ideal model. Conclusions The indicators soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 are independently associated with childhood sepsis, and the nomogram model established based on these indicators has high discriminatory ability and accuracy in the early diagnosis of sepsis in children. © 2022 Xiangya Hospital of CSU. All rights reserved.