经鼻持续气道正压治疗婴儿左向右分流先天性心脏病并心力衰竭的前瞻性研究

目的研究经鼻持续气道正压（NCPAP）改善婴儿左向右分流先心病并心衰患儿心肺功能的效果，评价该治疗方法的优点和安全性。方法左向右分流先心病并心衰患儿40例，20例随机分配到NCPAP组，予NCPAP治疗。其余20例作为对照组，给予面罩供氧治疗，综合治疗两组相同。在开始治疗时和治疗后1、12、24h记录呼吸频率、心率、PaO2、PaCO2、pH值、PaO2／FiO2等。结果治疗后1hNCPAP组呼吸频率、心率明显改善（P〈0．05）；PaO2和PaO2／FiO2均较对照组明显上升（P〈0．05），PaCO2较对照组下降（P〈0．05），且此趋势随时间推移持续。NCPAP组气管插管率显著低于对照组（P〈0．05）。结论NCPAP可改善左向右分流先心病并心衰患儿心肺功能和临床症状、体征，降低患儿气管插管的风险。

A prospective study of nasal continuous positive airway pressure for left-to-right shunt congenital heart disease infants with heart failure

Objective To investigate the effectiveness of nasal continuous positive airway pressure (NCPAP) in improving cardiorespiratory function in left-to-right shunt congenital heart disease infants with heart failure. Assess method quality and safety. Methods Forty left-to-right shunt congenital heart disease infants with heart failure were divided into 2 groups, a group that included 20 patients who decided to receive NCPAP and a control group of 20 patients that received face mask ventilation. Both groups were given conventional medications. Vital signs,PaO2, PaCO2,pH,and PaO2/FiO2 were recorded at the start and 1,12, and 24 hrs into the study. Results Heart rate and respiratory rate with NCPAP improved significantly(P ＜ 0.05). PaO2 and PaO2/FiO2 improved significantly compared with control group after 1 hrs. (P ＜ 0.05, respectively). The trend continued over time. The endotracheal intubation was significantly lower in the NCPAP group than in the control group (P ＜ 0.05). Conclusion Treatment with NCPAP improves cardiorespiratory function and the signs and symptoms of left-to-right shunt congenital heart disease infants with heart failure. NCPAP seems to afford these patients protection from endotracheal intubation.