肺表面活性物质联合经鼻持续正压通气治疗新生儿肺透明膜病临床效果分析

目的探讨肺表面活性物质(PS)联合经鼻持续正压通气(NCPAP)治疗新生儿肺透明膜病(HMD)的临床效果。方法将72例HMD患儿随机分为两组。观察组患儿37例,采用PS联合NCPAP治疗;对照组患儿35例,采用PS联合常频机械通气(CMV)治疗。观察比较两组患儿治疗前后的临床表现、血气分析结果及并发症发生率。结果观察组患儿肺炎发生率(21.6%)显著低于对照组患儿(54.3%),差异有统计学意义(P0.01);对照组患儿呼吸机所致肺损伤及气漏发生率分别为20.0%和14.3%,显著高于观察组患儿,差异有统计学意义(P0.05)。结论 PS联合NCPAP可有效治疗新生儿HMD,减少常频机械通气并发症发生。     

经鼻气道正压通气治疗新生儿肺透明膜病疗效观察

新生儿肺透明膜病（NRDS）是早产儿常见的合并症,是其死亡的重要原因。2005年3月2007年6月,我们用经鼻气道正压通气（NCPAP）治疗NRDS患儿18例,疗效满意。现报告如下。     

经鼻持续气道正压通气治疗新生儿呼吸困难疗效观察

2006年5月-2007年4月，我们采用经鼻持续气道正压通气（nCPAP）治疗新生儿呼吸困难24例，现报告如下。     

持续正压通气结合沐舒坦治疗新生儿肺透明膜病的疗效

目的探讨持续正压通气结合沐舒坦治疗新生儿肺透明膜病的临床疗效。方法选取2010年11月到2011年6月期间收治的82例新生儿肺透明膜病患儿,随机分成观察组41例和对照组41例,对照组患者给予持续正压通气治疗,观察组患者在持续正压通气治疗的同时结合沐舒坦进行治疗,比较两组患者的临床疗效。结果治疗前两组患者的PaO2、PaCO2数值没有显著性差异,治疗后两组患者的PaO2、PaCO2均较治疗前有明显改善,并且两组之间具有显著性差异;观察组胸片改善时间为（1.21±0.21）d,住院时间为（10.01±1.23）;对照组胸片改善时间为（3.21±0.43）d,住院时间为（17.43±3.21）d;观察组并发肺炎3例,颅内出血1例,肺出血2例,并发症发生率14.63%。对照组并发肺炎7例,颅内出血3例,肺出血5例,并发症发生率36.59%。结论持续正压通气结合沐舒坦治疗新生儿肺透明膜病具有确切的临床疗效,并且安全性较高,值得临床推广使用。     

肺表面活性物质联合新型鼻塞持续气道正压呼吸治疗新生儿肺透明膜病疗效分析

目的探讨肺表面活性物质Curosurf联合新型鼻塞持续气道正压呼吸(NCPAP)治疗新生儿肺透明膜病(HMD)的临床效果。方法将87例HMD患儿随机分为两组,观察组43例患儿经气管内注入Curosurf100mg·kg-1·次-1,然后拔管予NCPAP治疗;对照组44例患儿不用Curosurf治疗,比较两组患儿的临床治疗效果、并发症、住院时间、住院费用等。结果治疗后1h、12h、24h两组患儿的血气结果较治疗前显著改善,差异有统计学意义(P<0.05);两组治疗后比较差异亦有统计学意义(P<0.05)。观察组患儿的高压力、高FiO2及用NCPAP等各项所需时间较对照组明显缩短,差异均有统计学意义(P<0.05)。观察组治愈率为88.4%,对照组为63.6%,两组比较差异有统计学意义(P<0.05)。观察组肺炎的发生率明显低于对照组,差异有统计学意义(P<0.05)。观察组住院费用(18875±639)元,对照组总住院费用(18060±607)元,差异无统计学意义(P>0.05)。观察组住院(16±10)d,对照组(20±11)d,差异有统计学意义(P<0.05)。结论Curosurf联合NCPAP治疗HMD疗效确切,能快速有效地改善HMD的肺换气和通气功能,缩短住院天数及减少机械通气率和肺炎并发症的发生,住院费用没有增加。     

经鼻持续正压通气治疗新生儿急性呼吸衰竭临床研究

目的观察经鼻持续正压通气（NCPAP）治疗新生儿急性呼吸衰竭的疗效。方法对收治的22例急性呼吸衰竭新生儿使用NCPAP治疗后疗效及转归进行分析。结果治疗有效19例,无效3例。应用NCPAP后PO2、PaCO2、pH、R、HR均有明显改善（P〈0.05）。结论 NCPAP治疗新生儿呼吸衰竭有良好的治疗效果,可减少气管插管,减少机械通气,是一种简便、适宜的新生儿呼吸支持技术。     

经鼻双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征疗效观察

目的比较经鼻双水平气道正压通气(n Bi PAP)和经鼻持续气道正压通气(n CPAP)治疗早产儿呼吸窘迫综合征(RDS)的临床疗效。方法 RDS早产儿98例,随机分为n Bi PAP组(n=50)和n CPAP组(n=48),观察两组通气0、2、24 h血气、氧暴露时间、治疗成功率、住院天数、并发症。结果两组无创通气后2、24 h,p H值、Pa O2、Pa CO2均较0 h均有显著改善(P均<0.05)。通气后2 h,n Bi PAP组p H值、Pa O2、Pa CO2改善优于n CPAP组(P均<0.01)。通气后24 h,两组间Pa O2、p H比较,P>0.05;但n Bi PAP组Pa CO2低于n CPAP组(P<0.01)。n Bi PAP组的治疗成功率高于n CPAP组,氧暴露时间及住院天数均短于较n CPAP组,P均<0.05。两组坏死性小肠结肠炎、肺出血、气漏、颅内出血等发生率及病死率比较,P均>0.05。结论 n Bi PAP治疗早产儿RDS的疗效优于n CPAP,且可缩短氧暴露时间及住院天数,未增加不良反应。     

经鼻双相正压通气治疗新生儿呼吸暂停疗效观察

目的观察经鼻双相正压通气(N-BiPAP)治疗新生儿呼吸暂停的疗效。方法将我院新生儿监护病房诊断为呼吸暂停的患儿共58例,随机分为两组,每组29例。分别采用N-BiPAP和氨茶碱治疗,比较两组疗效。结果 N-BiPAP治疗后12 h及24 h,N-BiPAP组PaO2高于对照组,PaCO2低于对照组,差异均有统计学意义。结论对大多数新生儿呼吸暂停患儿采用N-BiPAP治疗能取得很好的临床疗效。     

经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床研究

目的探讨经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效价值及安全性,以期更好的为临床决策与发展提供相关依据。方法通过运用前瞻性研究方法,对我院自2014年1月-2016年1月期间收治患有呼吸窘迫综合征的120例新生儿随机分组,分别采用经鼻间歇正压通气或经鼻持续气道正压通气(NCPAP)联合肺表面活性物质进行治疗,对两组患儿治疗后的临床疗效加以评价。比较指标包括:氧合指数(OI)、pH值、PaO_2、PaCO_2、治疗成功率、病死率、辅助通气时间及肺漏气率等。结果两组治疗后PaO_2、pH值、OI值均显著升高,PaCO_2显著降低(P0.05)。治疗1 h时:间歇组PaO_2、pH值、OI值均显著高于持续组(P0.05),两组PaCO_2差异无统计学意义(P0.05)。治疗12 h:两组PaO_2、PaCO_2、pH值、OI值差异无统计学意义(P0.05)。另外,NIPPV组的治疗成功率明显高于NCPAP组(P0.05),而NCPAP组的辅助通气时间明显高于NIPPV组(P0.05),病死率、肺气漏比较无明显统计学差异(P0.05)。结论 NIPPV作为一种新型的无创呼吸机械通气技术,治疗效果更优,起效时间更快,治疗成功率更高,在NRDS的治疗中将有着广阔的前景,值得进行推广。     

经鼻气道正压通气治疗重叠综合征26例临床观察

阻塞型睡眠呼吸暂停低通气综合征(OSAHS)合并慢性阻塞性肺疾病(COPD)或其他呼吸系统疾病如肺囊性纤维化、肺间质纤维化等时称之为重叠综合征(overlap syndrome)。此类患者较单纯OSAHS或COPD有更严重的与睡眠有关的低氧血症,更容易引肺动脉高压以及发展成为慢性肺源性心脏病,并导致严重的并发症。     

The effect of continuous positive airway pressure therapy on nasal patency

Background

Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure (CPAP) users and are frequently cited as reasons for noncompliance. To our knowledge, no study has demonstrated a change in objective or subjective nasal patency in patients with obstructive sleep apnea (OSA) after a therapeutic trial of CPAP therapy.

Methods

This prospective nonrandomized trial tested the hypothesis that CPAP therapy would result in both objective and subjective improvements in nasal patency in patients with OSA. Prior to initiation of CPAP, acoustic rhinometry (AR) was used to determine nasal volume and minimum cross‐sectional area in the upright and reclined positions. Subjective nasal patency was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Both assessments were repeated at follow‐up visits.

Results

AR data demonstrated a statistically significant increase in total nasal volume (TV) in the reclined position (p = 0.002) and minimum cross‐sectional area (MCA) in both the sitting and reclined positions (p = 0.006, p = 0.021) in OSA patients after >30 days of CPAP therapy and with >70% compliance. NOSE scores decreased significantly (p = 0.038) representing an improvement in nasal patency.

Conclusion

Objective and subjective measurements of TV and MCA increased after initiation of CPAP therapy in this prospective study.

     

Ventilatory effects of nasal continuous positive airway pressure

Nasal continuous positive airway pressure (nCPAP) improved arterial oxygenation in patients with sleep apnoea as well as those with acute pulmonary processes such as Pneumocystis carinii pneumonia. Despite an expanding pool of clinical information, little if any attempt seems to have been made to see whether nCPAP alters ventilatory patterns. The effect of nCPAP was assessed by respiratory inductance plethysmography in 14 healthy males. nCPAP reduced respiratory rate (14.3 +/- 1.47 to 9.7 +/- 1.98, p less than 0.0001) but increased tidal volume (0.483 +/- 0.090 to 0.602 +/- 0.140 l, p = 0.01). Accordingly, minute ventilation decreased (6.91 +/- 1.20 to 5.64 +/- 0.93 l.min-1, p = 0.0002). Duty cycle (TI/TTOT) decreased from 0.43 +/- 0.04 to 0.35 +/- 0.05 s during nCPAP (p less than 0.0001). Mean inspiratory time and mean expiratory time increased with nCPAP (1.79 +/- 0.19 to 2.20 +/- 0.41 and 2.44 +/- 0.38 to 4.27 +/- 1.07 s, respectively, p less than 0.02), but there were no significant changes in mean inspiratory flow rate or partitioning of rib cage and abdominal/diaphragmatic contributions to tidal volume. We conclude that nCPAP effects ventilatory pattern in a manner similar to that described for expiratory threshold loading; that is, by decreasing respiratory frequency and minute ventilation. nCPAP does not appear to stimulate healthy subjects to increase their level of ventilation.     

经鼻持续气道正压通气治疗重叠综合征

目的探讨经鼻持续气道正压通气（nCPAP）治疗重叠综合征（OS）的疗效及安全性。方法对15例OS病人在家庭常规治疗的基础上采用nCPAP治疗6月,并观察、比较治疗前后多导睡眠图（PSG）有关参数、肺功能和动脉血气分析,并和15例同期只给予同样的常规药物治疗OS患者比较。结果nCPAP治疗OS患者组睡眠呼吸暂停低通气指数（AHI）由治疗前的（36.8±14.2）次/h下降到（4.5±1.2）次/h,夜间最低血氧饱和度（LSaO2）由（69.5±9.2）%上升到（88.1±5.3）%,平均血氧饱和度（MSaO2）由（86.1±7.1）%上升到（94.6±1.6）%,90%以下氧减饱和度指数（DOI）由46.5±11.5下降到4.0±2.2,以及肺功能和动脉血氧分压都较治疗前和对照组显著改善（P〈0.05）。动脉血气二氧化碳分压（PaCO2）由治疗前（6.0±1.2）kPa降到（5.5±1.9）kPa,治疗前后及与对照组相比差异无显著性（P〉0.05）。结论nCPAP治疗OS是安全、有效的,且价格便宜,对基层医院和家庭治疗具有实用性。     

Improved morbidity with the use of nasal continuous positive airway pressure in I-cell disease

Patients with I-cell disease (mucolipidosis II) present with progressive morbidity failure to thrive, cardiomegaly, and recurrent respiratory tract infections leading to progressive deterioration and early death. We evaluated use of nasal continuous positive airway pressure (NCPAP) for 6 months in a 2-year-old girl with I-cell disease, obstructive sleep apnea (OSA), and craniofacial anomalies. We observed a marked decrease in hospitalizations for respiratory problems and a marked improvement in arterial blood gases with the use of NCPAP. In patients with I-cell disease, anatomical defects with superimposed upper respiratory tract infections cause worsening of OSA, and OSA contributes significantly to morbidity. In such patients NCPAP can lessen morbidity and can improve the quality of life. Pediatr. Pulmonol. 1998; 25:128–129. © 1998 Wiley-Liss, Inc.     

The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness

Purpose  

We performed a pilot study to determine whether nasal continuous positive airway pressure (CPAP) alleviates the symptoms of veterans with Gulf War illness (GWI) and sleep disordered breathing (SDB).     

Routine use of humidification with nasal continuous positive airway pressure

Background: Heated humidification can reduce nasal symptoms caused by continuous positive airway pressure (CPAP) treatment, but its routine use has not been studied over the medium term in a randomized controlled trial. The aim of this study is to determine if heated humidification would reduce nasal symptoms and improve adherence with CPAP treatment in all patients with sleep apnoea irrespective of whether they had nasal symptoms initially. Methods: A randomized, parallel group design. Patients were treated for 3 months with a Fisher & Paykel HC201 pump with built‐in heated humidification, or with the heater disabled and without water. Adherence was measured with a timer built into the pumps. Nasal symptoms were measured with a 10‐cm visual analogue scale. Results: There were 25 in the humidification group and 29 in the non‐humidification group. After 12 weeks mean (standard deviation) adherence with CPAP was 4.7 (2.4) and 4.5 (2.2) hours per night respectively. Nasal symptoms that were reduced were nose blocked* 6 (12), 18 (26); sneezing* 4 (8), 15 (25); dry nose* 8 (12), 24 (33); stuffy nose* 7 (14), 22(31); dry mouth* 13 (18), 33(36); and runny nose* 6 (17), 14 (29). Parameters marked with an asterisk ‘*’ had P < 0.05 with t‐tests. Conclusion: The routine use of heated humidification with CPAP in all patients with sleep apnoea reduced nasal symptoms, but did not improve adherence.