高浓度氧疗对比滴定氧疗治疗儿童哮喘的随机对照研究

摘要]目的：对比高浓度氧疗与滴定氧疗对儿童哮喘急性发作患儿经皮二氧化碳分压（PtCO2）的影响。方法：选取因中度或重度哮喘发作就诊于我院的100例2~18岁哮喘病患儿为研究对象，随机分为高浓度氧疗组（HCOT组）或滴定氧疗组（TOT组），在0、20、40、60、90 min时测量PtCO2、哮喘评分，并对两组患儿住院率进行对比分析。结果：60 min时，HCOT组患儿PtCO2升高>4 mm Hg和PtCO2升高>6 mm Hg比例高于TOT组，HCOT组患儿PtCO2升高>4 mm Hg且PtCO2>38 mm Hg比例高于TOT组（P<0.05）。HCOT组PtCO2平均升高速率均高于TOT组，哮喘评分高于TOT组，90 min时HCOT组呼气高峰流量（PEFR）高于TOT组（P<0.05）。HCOT组住院率44.0%（22/50），高于TOT组的30.0%（15/50），但差异无统计学意义（P>0.05）。结论：儿童哮喘急性发作期高浓度氧疗可导致PtCO2水平明显升高，哮喘评分升高，入院率呈上升趋势。治疗儿童哮喘急性发作时，并不需要为所有患儿提供高浓度氧气治疗，采用滴定氧疗使血氧饱和度维持在92%以上，能同时避免低氧血症和高碳酸血症的发生。

Randomized Controlled Trial of Comparison of High Concentration Oxygen Therapy and Titration Oxygen Therapy for Children with Asthma

Abstract] Objective: To compare the effects of high concentration oxygen therapy and titration oxygen therapy on percutaneous carbon dioxide partial pressure (PtCO2) in children with acute asthma. Methods: Totally 100 children with asthma aged from 2 to 18 years who were admitted to our hospital due to the moderate or severe asthma attack were selected to be randomly divided into the high concentration oxygen therapy group (HCOT group) or the titrated oxygen therapy group (TOT group). PtCO2 and asthma scores were measured at 0, 20, 40, 60, and 90 min, and the admission rate of two groups were compared and analyzed. Results: At 60 min, the proportion of PtCO2 increased by >4 mm Hg and PtCO2 increased by >6 mm Hg in the HCOT group was significantly higher than that in the TOT group. The proportion of PtCO2 increased by >4 mm Hg and PtCO2 increased by >38 mm Hg in the HCOT group was significantly higher than that in the TOT group (P<0.05). The average elevation rate of PtCO2 in the HCOT group was higher than that in the TOT group, the asthma score was higher than that in the TOT group. The peak expiratory flow rate (PEFR) of HCOT group was higher than that of TOT group at 90 min (P<0.05). The admission rate in the HCOT group was 44.0% (22/50), higher than that in the TOT group (30.0%, 15/50), yet the difference was not statistically significant (P>0.05). Conclusion: High concentration oxygen therapy in children with acute asthma can lead to a significant increase in PtCO2 levels, an increase in asthma scores, and an increase in admission rate. Therefore, in the treatment of acute asthma in children, it is not necessary to provide high concentration oxygen therapy for all patients, titration oxygen therapy can maintain the oxygen saturation of blood at more than 92%, which can simultaneously avoid hypoxemia and hypercapnia.