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目的探讨院前无创机械通气治疗小儿支气管肺炎并急性左心衰竭的临床疗效。方法 60例小儿支气管肺炎并急性左心衰竭患儿,给予常规治疗无明显好转,及早给予无创机械通气治疗,观察治疗前及治疗后2 h氧分压(Pa O2)、二氧化碳分压(Pa CO2)、动脉血氧饱和度(Sa O2)、心率(HR)、呼吸频率(RR)等变化,并测定左室射血分数(LVEF)、短轴缩短率(FS)及Tei指数等,制定相应急救措施。结果 58例患儿生命体征平稳,有2例病情加重,及时改为气管插管有创通气抢救,无创机械通气有效率96.7%。对支气管肺炎并急性左心衰竭患儿紧急进行无创机械通气治疗2 h后,患儿Pa O2、Pa CO2、Sa O2、HR、RR较治疗前明显改善(P<0.05)。无创通气后患儿Tei指数、LVEF及FS分为别为(0.58±0.05)、(49.12±6.84)%、(41±11)%,优于无创通气前的(0.76±0.06)、(41.08±8.82)%、(33±4)%(P<0.05)。结论对于常规治疗无效的小儿支气管肺炎并急性左心衰竭患儿紧急进行院前无创机械通气抢救治疗可及时有效地改善的临床症状,迅速缓解肺水肿及呼吸困难情况,纠正低氧血症,是急诊救治小儿支气管肺炎并急性左心衰竭的有效抢救措施,可临床推广。
Objective To investigate the clinical effect of prehospital noninvasive mechanical ventilation on children with bronchopneumonia and acute left heart failure. Methods Sixty children with bronchopneumonia and acute left heart failure were treated with noninvasive mechanical ventilation as early as possible and without preconditioning. The Pa (subscript O2), Pa (subscript CO2), Pa ), Arterial oxygen saturation (Sa O2), heart rate (HR), respiration rate (RR) and other changes, and measured left ventricular ejection fraction (LVEF), short axis shortening (FS) and Tei index, first-aid. Results 58 cases of children with stable vital signs, 2 cases aggravate, promptly replaced by tracheal intubation invasive ventilation rescue, non-invasive mechanical ventilation efficiency of 96.7%. PaO2, PaCO2, SaO2, HR, RR in children with bronchopneumonia and acute left heart failure were significantly improved (P <0.05) after 2 hours of emergency non-invasive mechanical ventilation. The Tei index, LVEF and FS in infants with non-invasive ventilation were (0.58 ± 0.05), (49.12 ± 6.84)% and (41 ± 11)%, respectively, which were better than those before noninvasive ventilation (41.08 ± 8.82)%, (33 ± 4)% (P <0.05). Conclusions For children with bronchopneumonia and acute left heart failure who are ineffective in conventional treatment, emergency treatment of non-invasive mechanical ventilation in hospital for pre-hospital emergency treatment can effectively improve the clinical symptoms, rapid relief of pulmonary edema and dyspnea, correct hypoxemia, is Emergency treatment of children with bronchial pneumonia and acute left heart failure effective rescue measures can be clinically promoted.