经鼻持续气道正压通气联合磷酸肌酸钠治疗新生儿重症肺炎合并心力衰竭的临床研究

目的:探讨经鼻持续气道正压通气(nCPAP)联合磷酸肌酸钠治疗新生儿重症肺炎合并心力衰竭(心衰)的临床效果.方法:将74例重症肺炎合并心衰患儿采用抽签法随机分为治疗组46例与对照组28例.对照组给予头罩给氧、暖箱保暖、抗感染、强心、利尿等对症支持治疗及磷酸肌酸钠1 g/d静脉滴注,14 d一个疗程,治疗组在此基础上予nCPAP辅助治疗.结果:在气促消失、心率恢复正常、肝脏回缩、肺部啰音消失、动脉血气恢复正常、缩短平均住院日方面,治疗组均优于对照组(P＜0.05或P＜0.01).治疗组显效率93.5％明显高于对照组60.7％(P＜0.01);治疗组总有效率97.8％明显高于对照组71.4％ (P＜0.01).结论:nCPAP联合磷酸肌酸钠为治疗新生儿重症肺炎合并心衰的有效方法,能迅速纠正低氧血症,改善心肺功能,减少对气管插管和机械通气的需求,避免呼吸机相关并发症的发生,降低病死率,值得临床推广.

Clinical Research on Treatment of Neonates with Severe Pneumonia Complicated with Heart Failure by nCPAP and Creatine Phosphate Sodium

Objective: To explore clinical effect for treatment of neonates with severe pneumonia complicated with heart failure by nasal continuous positive airway pressure(nCPAP)and creative phosphate sodium.Methods: Seventy-four cases of severe pneumonia complicated with heart failure in neonates were randomly divided into treatment group 46 cases and control group 28 cases.The same treatment included incubator warm,anti-infections,cardiotonic,diuretic,vasoactive drugs,oxygen drive atomization,suctioning,support and intravenous drip of creatine phosphate sodium 1 g/d×14 days were used for the two groups.Head coverings for oxygen were used in the control group,and nCPAP was used in the treatment group.Results: The treatment group was significantly better than the control group in the relieving of shortness of breath,normal heart rate,liver retraction,diminution of pulmonary rales,return of arterial blood-gas,and reducing the average length of stay(P<0.05 or P<0.01).The especially effective rate and total effective rate of the treatment group(93.5%,97.8%) were higher than those of the control group(60.7%,71.4%),(χ2 =4.30,P<0.01).The comparative differences of two groups were statistically significant.Conclusions: The treatment of neonates with severe pneumonia complicated with heart failure by nCPAP and creatine phosphate sodium is an effective method.It can correct hypoxemia quickly,improve functions of heart and lungs,reduce the need for endotracheal intubation and mechanical ventilation,avoid the occurrence of ventilator associated complications,and reduce the mortality rate.nCPAP and creatine phosphate sodium therapy for neonates with severe pneumonia complicated with heart failure can be widely used in practice.