摘要
目的探讨早期俯卧位通气在小儿脓毒症合并急性呼吸窘迫综合征(ARDS)中的应用效果。方法选取湖州市中心医院儿科2017年1月-2019年12月期间收治的脓毒症合并ARDS患儿42例,按数字随机表法将患儿分为观察组(21例)和对照组(21例)。2组患儿在常规气管插管机械通气基础上,均采用俯卧位通气策略,对照组在开始使用呼吸机24 h及以后实施俯卧位通气,观察组在开始使用呼吸机6 h内实施俯卧位通气。对比2组患儿相关指标和并发症发生情况。结果观察组较对照组心率更加稳定[(96.3±6.4)次/min vs.(109.6±10.1)次/min],且能降低气道平台压[(17.5±5.5)cm H2O vs.(24.7±4.1)cm H2O,1 cm H2O=0.098 kPa]、明显提高动脉氧分压[(109.8±24.7) mm Hg vs.(67.5±22.8)mm Hg,1 mm Hg=0.133 kPa]、更好地改善氧合指数(114.2±20.6 vs. 89.1±17.2),并明显缩短了患儿气管插管机械通气时间[(7.0±0.8)d vs.(11.6±1.8) d],提高了治愈率(95.23%vs. 66.67%),差异有统计学意义(均P<0.05),而2组相关并发症发生率比较,差异无统计学意义(均P>0.05)。结论早期俯卧位通气的实施能更明显改善脓毒症合并ARDS患儿的氧合指数,稳定心率和降低气道平台压,缩短气管插管机械通气时间并提高治愈率,且相关并发症无明显增加,值得临床推广。
Objective To explore the effect of early prone position ventilation on children with sepsis and acute respiratory distress syndrome(ARDS). Methods Forty-two children with sepsis and ARDS who were admitted to the Pediatrics Department of Huzhou Central Hospital from January 2017 to December 2019 were selected, and they were randomly divided into observation group and control group, 21 cases of each. The two groups of children on the basis of conventional tracheal intubation and mechanical ventilation, the prone position ventilation strategy for both groups were adopted. The children of control group received prone ventilation within 24 hours and later of starting MV, while the children in the observation group performed prone ventilation within 6 hours of starting MV. The related indicators and complications were compared between the two groups. Results Compared with the control group, the observation group could stabilize heart rate faster [(96.3±6.4)beats/min vs.(109.6±10.1)beats/min], reduce airway platform pressure [(17.5±5.5)cm H2O vs.(24.65±4.1)cm H2O], increase arterial oxygen partial pressure significantly [(109.8±24.7)mm Hg vs.(67.5±22.8)mm Hg] and better improve the oxygenation index(114.2±20.6 vs. 89.1±17.2), as well as obviously shorten that mechanical ventilation time of tracheal intubation of children [(7.0±0.8)d vs.(11.6±1.8)d], improve the cure rate(95.23% vs. 66.67%), the differences were statistically significant(all P<0.05). However, the incidence of related complications in the two groups no statistically significant differences(all P>0.05). Conclusion The early prone position ventilation can significantly improve oxygenation index of septic children complicated with ARDS, stabilize heart rate faster, reduce airway platform pressure, shorten mechanical ventilation time of tracheal intubation and improve cure rate, but has no significant increase in which is worthy of clinical promotion.
作者
余敏敏
钟剑峰
龚晓莉
徐震
YU Min min;ZHONG Jian-feng;GONG Xiao-li;XU Zhen(Department of Pediatrics,Huzhou Central Hospital,the Afiliated Central Hospital of Huzhou University,Huzhou,Zhejiang 313000,China)
出处
《中华全科医学》
2020年第11期1957-1960,共4页
Chinese Journal of General Practice
基金
浙江省基础公益研究计划(GD20H190001)。
