小剂量糖皮质激素联合小潮气量、肺复张在重症肺炎肺损伤患儿中的应用

目的:观察小剂量糖皮质激素联合小潮气量、肺复张(RM)治疗重症肺炎肺损伤患儿的临床有效性及安全性。方法:入我院PICU 符合重症肺炎肺损伤患儿42例,随机分为试验组和对照组各21例,所有入选患儿均给予常规治疗、小剂量糖皮质激素,试验组入院24 h内给予小潮气量(VT:6~8 mL/kg)机械通气和RM,对照组只给予机械通气(VT:8~10 mL/kg)。分析两组患儿血流动力学、呼吸力学、血气变化、预后及并发症。结果:试验组患儿在小剂量糖皮质激素、小潮气量基础上共进行RM操作73例次, RM后5 min、15 min、60 min气道峰压、呼吸频率、呼气末压力、吸气氧体积分数、平均气道压水平均低于RM前(P<0.05);呼吸频率、平均动脉压RM前后比较差异无统计学意义(P>0.05);两组血气分析均较通气前改善(P<0.05);通气后两组患儿PaO2 / FiO2、肺动态顺应性、呼气功比较差异有统计学意义(P<0.05);试验组机械通气时间、吸氧时间、住院时间均较对照组短,并发症较对照组减少(P<0.05)。结论:小剂量糖皮质激素联合小潮气量、RM可以改善重症肺炎肺损伤患儿氧合功能,提高患儿肺的顺应性,患儿耐受性良好,能缩短患儿机械通气时间、氧暴露时间、住院时间,减少不良反应。

The Application of Small Dose Glucocorticoid Combined with Low Tidal Volume, Lung Recruitment Maneuver in Treatment of Infantile Severe Pneumonia Complicated by Acute Lung Injury

Objective: To observe the effects and safety of small dose glucocorticoid combined with low tidal volume, lung recruitment maneuver (RM) on infantile severe pneumonia complicated by acute lung injury (ALI). Methods: Forty two children with infantile severe pneumonia in our hospital PICU were randomly divided into experimental group and control group, each group with 21 cases. All children were given etiological treatment and small dose glucocorticoid. Experimental group were given low tidal volume (VT: 6~8 mL/kg) mechanical ventilation and lung RM with 24 hours after admission, control group were only given mechanical ventilation (VT: 8~10 mL/kg). Variations in hemodynamic parameters, respiratory mechanics, blood gas, prognosis and complication were measured. Results: Children of experimental group were done a total of 73 RMs based on the small dose glucocorticoid and low tidal volume. Compared with the data before RM, the PIP, R, PEEP, FiO2, Paw were all lower in RM 5 min, 15 min, 60 min. R, MAP before and after RM were stable (P>0.05), pH, PaO2, PaCO2 were improved (P<0.05). The differences between the two groups of PaO2 /FiO2, Cdyn, Wobv were statistically significant after mechanical ventilation (P<0.05). Mechanical ventilation time, oxygen inhalation time, hospitalization time, complications occurred of the experimental group were shorter compared with the control group (P<0.05). Conclusion: Small dose glucocorticoid combined with low tidal volume and RM can significantly improve the oxygenation and the lung compliance in treatment of children with infantile severe pneumonia. RM was well tolerated in children. It can shorten the mechanical ventilation time, oxygen exposure time, hospitalization time and complications occurred.