目的 探究应用高频振荡通气（HFOV）模式下早期肺表面活性物质干预对呼吸窘迫综合征致重度呼吸衰竭患儿转归的影响。方法 选取南阳医学高等专科学校第一附属医院2020年6月—2022年12月收治的120例呼吸窘迫综合征致重度呼吸衰竭患儿作为研究对象,按照随机数字表法将其分为对照组与研究组各60例,对照组行常规通气联合早期肺表面活性物质干预,研究组行HFOV联合早期肺表面活性物质干预,对比两组患儿临床症状、血气指标、肺功能指标、患儿转归分析、并发症以及临床疗效。结果 研究组患儿症状消失时间为（31.28±10.24）h、呼吸机辅助通气时间为（50.13±15.81）h以及住院天数为（12.47±5.48）d,对照组患儿症状消失时间为（59.91±11.56）h,呼吸机辅助通气时间为（91.17±25.47）h及住院天数为（20.11±9.45）d,研究组低于对照组（P<0.05）;治疗后,研究组患儿PaO₂为（77.89±9.10）mmHg,PaCO₂为（41.09±8.25）mmHg,氧合指数为（432.18±37.81）mmHg,对照组患儿PaO₂为（65.28±8.16）mmHg,PaCO₂为（49.71±8.91）mmHg,氧合指数为（258.64±56.74）mmHg,研究组PaO₂、氧合指数高于对照组,且PaCO₂低于对照组（P<0.05）;治疗后,研究组患儿体重潮气量（TV）为（7.68±2.16）mL/kg,达峰容积比（TPEF/TE）为（34.19±4.06）%,达峰时间比（VPEF/VE）为（33.47±3.42）%,对照组患儿TV为（6.64±2.01）mL/kg,TPEF/TE为（28.66±3.81）%,VPEF/VE为（28.95±3.10）%,研究组高于对照组（P<0.05）;研究组患儿支气管肺发育不良（BPD）为11.66%,对照组为13.33%,两组患儿BPD发生率比较差异无统计学意义（P>0.05）;研究组IVH为3.33%、ROP为5.00,对照组脑室内出血（IVH）为8.33%,早产儿视网膜病（ROP）为11.66%,研究组低于对照组（P<0.05）;研究组患儿并发症发生率为6.66%,对照组患儿并发症发生率为20.00%,研究组低于对照组（P<0.05）;研究组患儿总有效率为96.66%,对照组患儿总有效率为83.33%,研究组高于对照组（P<0.05）。结论 HFOV模式下早期肺表面活性物质干预呼吸窘迫综合征致重度呼吸衰竭患儿效果显著,改善患儿呼吸功能与血气指标,并发症较少。

Objective To investigate the effect of early intervention with pulmonary surfactant under HFOV mode on the outcome of severe respiratory failure in children with respiratory distress syndrome．Methods A total of 120 children with severe respiratory failure caused by respiratory distress syndrome admitted to our hospital from June 2020 to December 2022 were selected as the study subjects．They were randomly divided into a control group and a study group of 60 cases each using a random number table method．The control group received routine ventilation combined with early pulmonary surfactant intervention,while the study group received HFOV combined with early pulmonary surfactant intervention．Symptom disappearance,ventilator-assisted ventilation,hospital stay,blood gas indicators,lung function indicators,analysis of pediatric outcomes,complications,and clinical efficacy were compared between the two groups．Results The time of symptom disappearance was（31.28±10.24）h,the duration of ventilator assisted ventilation was（50.13±15.81）h and the number of days in hospital was（12.47±5.48）d in the study group,while the time of symptom disappearance was（59.91±11.56）h,the duration of ventilator assisted ventilation was（91.17±25.47）h and the number of days in hospital was（20.11±9.45）d in the control group,which were higher than those in the study group（P<0.05）．After treatment,PaO₂ was （77.89±9.10）mmHg,PaCO₂ was （41.09±8.25）mmHg and oxygenation index was （432.18±37.81）mmHg in the study group,while PaO₂ was （65.28±8.16）mmHg,PaCO₂ was （49.71±8.91）mmHg and oxygenation index was （258.64±56.74）mmHg in the control group．The PaO₂ and oxygenation index of the study group were higher than those of the control group,and the PaCO₂ was lower than that of the control group（P<0.05）．After treatment,TV in the study group was （7.68±2.16）mL/kg,TPEF/TE was （34.19±4.06）%,VPEF/VE was （33.47±3.42）%,and TV in the control group was （6.64±2.01）mL/kg,TPEF/TE was （28.66±3.81）%,VPEF/VE was （28.95±3.10）%．The study group was higher than the control group（P<0.05）．BPD was 11.66% in the study group and 13.33% in the control group．There was no significant difference in the incidence of BPD between the two groups（P>0.05）．The IVH and ROP of the study group were 3.33% and 5.00 respectively,while those of the control group were 8.33% and 11.66% respectively,which were lower in the study group（P<0.05）．The incidence of complications was 6.66% in the study group and 20.00% in the control group,which was lower in the control group（P<0.05）．The total effective rate was 96.66% in the study group and 83.33% in the control group,which was higher in the control group（P<0.05）．Conclusion sEarly intervention of pulmonary surfactant in children with severe respiratory failure caused by respiratory distress syndrome under HFOV mode has a significant effect,improving respiratory function and blood gas indicators,and reducing complications．

目的 观察经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭对患者肺功能、血气分析指标的影响。方法 收集2020年3月—2022年3月我院收治的AECOPD伴Ⅱ型呼吸衰竭患者92例,随机分为常规通气组（46例,无创正压通气）、经鼻氧疗组（46例,经鼻高流量氧疗）,测量记录治疗前及治疗后2组患者心率及呼吸频率、血气分析指标、肺功能指标,评估患者舒适度及呼吸困难情况,记录治疗期间并发症。结果 治疗后经鼻氧疗组心率、呼吸频率低于常规通气组（P<0.05）;治疗后经鼻氧疗组二氧化碳分压（PaCO₂）低于常规通气组,动脉血氧分压（PaO₂）高于常规通气组（P<0.05）;治疗后经鼻氧疗组第1秒用力呼出气容积（FEV₁）、用力呼气容积（FVC）高于常规通气组（P<0.05）;治疗后经鼻氧疗组Borg评分低于常规通气组,舒适率高于常规通气组（P<0.05）;经鼻氧疗组并发症发生率低于常规通气组（P<0.05）。结论 给予AECOPD伴Ⅱ型呼吸衰竭患者经鼻高流量氧疗可改善患者肺功能、血气分析指标,促进呼吸困难症状缓解,且可提高患者舒适度,降低并发症发生率。

Objective To observe the effect of nasal high-flow oxygen therapy on pulmonary function and blood gas analysis indexes in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with type Ⅱ respiratory failure．Methods From March 2020 to March 2022,92 patients with AECOPD complicated with type Ⅱ respiratory failure who were treated in our hospital were enrolled and randomly divided into conventional ventilation group（46 cases,non-invasive positive pressure ventilation）and nasal oxygen therapy group（46 cases,nasal high-flow oxygen therapy）．The heart rate and respiratory rate,blood gas analysis indexes,pulmonary function indexes of the two groups of patients before and after treatment were measured and recorded,the comfort level and dyspnea situation of the patients were evaluated,and the complications during the treatment were recorded．Results After treatment,the heart rate and respiratory rate in the nasal oxygen therapy group were significantly lower than those in the conventional ventilation group（P<0.05）．The partial pressure of carbon dioxide（PaCO₂）in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group,partial pressure of oxygen（PaO₂）was significantly higher than the conventional ventilation group（P<0.05）．The nasal oxygen therapy group forced expiratory volume in one second,（FEV₁）,forced vital capacity（FVC）were significantly higher than the conventional ventilation group（P<0.05）．The Borg score of nasal oxygen therapy group was significantly lower than the conventional ventilation group,the comfort level was significantly higher than the conventional ventilation group（P<0.05）．The incidence of complications in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group（P<0.05）．Conclusions Nasal high-flow oxygen therapy for AECOPD patients with type Ⅱ respiratory failure can significantly improve the pulmonary function and blood gas analysis indicators,promote the relief of dyspnea symptoms,improve the comfort level of patients,and reduce the incidence of complications．

目的 探讨集束化护理模式在AECOPD并呼吸衰竭患者初次无创通气中的作用。方法 选我院2016年10月—2018年12月收治AECOPD并呼吸衰竭需初次无创通气的患者为研究对象,随机分为对照组和观察组,对照组予传统护理,观察组予集束化护理,各30例;分别记录两组患者每日无创通气时间、总住院时间、循环呼吸指标(HR、RR)、指尖血氧饱和度、血气分析、并发症、患者满意度和护理质量。结果 观察组患者的每日无创通气时间,指尖血氧饱和度、pH值、氧分压和二氧化碳分压改善均优于对照组,并发症发生率和住院时间低于对照组,满意度和护理质量较高(P<0.01)。结论 集束化护理可以提高AECOPD并呼吸衰竭患者无创通气的疗效,减少并发症、缩短住院天数,改善预后。

目的 探讨脑钠肽(BNP)在协助判断肺结核合并呼吸衰竭疗效及预后的价值。方法 2013年1月—2014年12月我院收治初治菌阳肺结核合并呼衰共81例,分别在抗结核、呼衰治疗前及2 周末行BNP、动脉血气分析及胸部X线检查;按住院号对应随机数字表随机抽取我院同期初治菌阳肺结核无合并呼衰104例作为对照组,采集两组数据进行回顾性病例对照研究。结果 肺结核合并呼衰BNP高于单纯肺结核11.4倍(1115.11 pg/mL比97.60 pg/mL),全肺结核高于非全肺结核3.4倍(1549.82 pg/mL比449.47 pg/mL)。治疗前BNP与PaO₂、SaO₂和pH值呈负相关,与PaCO₂呈正相关,治疗后两者无相关性。2周末 BNP是治疗前0.57倍(632.41 pg/mL比1115.11 pg/mL),死亡组高于存活组8.7倍(3119.63 pg/mL比359.84 pg/mL)。结论 肺结核合并呼衰BNP升高,治疗后随病情好转持续下降,有可能成为协助判断疗效及估测预后的指标之一。

Objective Discussion about value of brain natriuretic peptide (BNP) in helping to determine the efficacy and prognostic of pulmonary tuberculosis combine with respiratory failure. Methods 81 cases were admitted from January 2013 to December 2014 in our hospital of early treatment sputum positive pulmonary tuberculosis with respiratory failure. And the cases were carried out BNP, arterial blood gas analysis and chest X-ray before treatment and after two weeks respectively.104 cases of earlier sputum positive pulmonary tuberculosis accompanied with respiratory failure were randomly drawn according to the corresponding random number of hospitalization as a control group. Two sets of data were collected to conduct retrospective case-control study. Results BNP of pulmonary tuberculosis combine with respiratory failure is 11.4 times higher than that of tuberculosis alone (1115.11 pg/mL compare 97.60 pg/mL), the whole TB is 3.4 times higher than non-full-tuberculosis (1549.82 pg/mL t compare 449.47 pg/mL). Before treatment, BNP was negatively correlated to PaO₂, SaO₂ and pH BNP was positively correlated with PaCO₂. There was no correlation after treatment between BNP and PaCO₂.After two weeks BNP is 0.57 times of the pre-treatment (632.41 pg/mL compared 1115.11 pg/mL). The group of death is 8.7 times higher than the survival group (3119.63 pg/mL compared 359.84 pg/mL). Conclusion BNP was significantly increased in patient accompanied tuberculosis with respiratory failure .The condition is continued to decline after treatment. There is likely to be one of the indicators of helping to determine the efficacy and estimate prognosis.