鼻持续气道正压通气治疗毛细支气管炎：一项随机对照试验

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial.

作者信息

Lal Sandeep Narayan, Kaur Jaspreet, Anthwal Pooja, Goyal Kanika, Bahl Pinky, Puliyel Jacob M

机构信息

Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India. Correspondence to: Dr Sandeep Narayan Lal, Department of Pediatrics, St Stephens Hospital, Tis Hazari, Delhi 110054, India.

Department of Pediatrics, St. Stephens Hospital, Tis Hazari, Delhi, India.

出版信息

Indian Pediatr. 2018 Jan 15;55(1):27-30. Epub 2018 Sep 26.

PMID:28952459

Abstract

OBJECTIVE

To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis.

DESIGN

Randomized controlled trial.

SETTING

Tertiary-care hospital in New Delhi, India. Participants: 72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.

PARTICIPANTS

72 infants (age <1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.

INTERVENTION

The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis.

MAIN OUTCOME MEASURES

Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score.

RESULTS

14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate [8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively.

CONCLUSIONS

nCPAP helped reduce respiratory distress significantly compared to standard care.

摘要

目的

评估经鼻持续气道正压通气（nCPAP）减轻细支气管炎患儿呼吸窘迫的疗效。

设计

随机对照试验。

地点

印度新德里的三级医疗医院。参与者：72名临床诊断为细支气管炎的住院婴儿（年龄<1岁），在入院后第一小时被随机分为接受标准治疗，或在标准治疗基础上加用nCPAP。23名家长拒绝参与同意书。2名婴儿不耐受nCPAP。

参与者

72名临床诊断为细支气管炎的住院婴儿（年龄<1岁），在入院后第一小时被随机分为接受标准治疗，或在标准治疗基础上加用nCPAP。23名家长拒绝参与同意书。2名婴儿不耐受nCPAP。

干预措施

60分钟后评估结果。如果不耐受nCPAP或呼吸窘迫加重，则将婴儿改为标准治疗。分析采用意向性分析。

主要观察指标

呼吸频率变化、Silverman-Anderson评分和改良新西兰儿科学会严重程度评分。

结果

nCPAP组32例中有14例、标准治疗组35例中有5例呼吸频率变化≥10（P=0.008）。nCPAP组和标准治疗组在呼吸频率平均（标准差）变化[8.0（5.8）对5.1（4.0），P=0.02]、Silverman-Anderson评分[0.78（0.87）对0.39（0.73），P=0.029]和改良新西兰儿科学会严重程度评分[2.5（3.01）对1.08（1.3），P=0.012]方面分别有显著差异。