小潮气量肺保护通气策略在急性低氧性呼吸衰竭中的应用

目的探讨小潮气量(VT)和传统VT机械通气在急性低氧性呼吸衰竭(AHRF)治疗中的安全性的差异,评估小VT通气策略的疗效。方法将133例AHRF患儿分为传统VT通气组32例和小VT通气组101例,根据VT调整呼气末正压(PEEP),监测肺动态顺应性(Cdyn)、呼吸功(WOB)、呼吸道阻力(Raw)、呼吸道闭合压(P0.1)、肺泡气-动脉血氧分压差p(A-a)(O2)]、氧合指数(OI)、血气分析等指标变化,观察患儿氧合改善情况、机械通气并发症发生、撤机情况以及患儿转归情况。结果 1.小VT组与传统VT组,Cdyn、Raw在上机1 d、3 d,WOB在上机3 d、5 d,P0.1在上机5 d、7 d比较差异均有统计学意义(Pa<0.05)。小VT通气24 h氧合改善较传统VT通气明显,pa(O2)、p(A-a)(O2)、OI比较差异均有统计学意义(Pa<0.05)。2.小VT组呼吸机相关性肺损伤发生率明显低于传统VT组,差异有统计学意义(P<0.05)。3.危重患儿病死率比较无明显差异。结论 Cdyn、Raw、WOB、P0.1等呼吸力学指标有助于判断机械通气过程中患儿肺部病变情况,及时调整呼吸机参数并判断撤机时机。在降低呼吸机相关性肺损伤的发生方面,小VT通气优于传统VT通气。小VT通气在降低AHRF患儿病死率方面,并不优于传统VT通气。

Application of Lung Protective Ventilation Strategies of Low Tidal Volume in Children with Acute Hypoxemic Respiratory Failure

Objective To explore the differences of safety between low tide volume ventilation and traditional ventilation therapy on acute hypoxemic respiratory failure(AHRF) in children and assess the curative effect of low tide volume ventilatory strategy.Methods One hundred and thirty-three patients with AHRF were divided into traditional tide volume ventilation group(n=32),small tide volume ventilation group(n=101).The positive end expiratory pressures(PEEP) was adjusted correctly according to patient’s tidal volume,and some indexes were monitored,such as monitored dynamic compliance(Cdyn),work of breathing(WOB),air way resistance(Raw),airway occlusion pressure at 0.1 second(P0.1),alveolar-arteral pressure of oxygen differencep(A-a)(O2)],oxygen index(OI),blood gas analysis,and so on.To observe the oxygenation,complication,removing ventilator and prognosis of the critical cases.Results Comparison between low tidal volume ventilation group and traditional tide volume ventilation group: 1.There were significant differences in the results of Cdyn and Raw on the 1st day and 3th day,WOB on the 3th day and 5th day,P0.1 on the 5th day and 7th day(Pa<0.05).The parameter of oxygenation was significantly improved in low tidal volume ventilation group at 24 hours.There were significant differences in the results of pa(O2),p(A-a)(O2),OI(Pa<0.05).2.Compare with the rate of ventilator associated lung injury in the 2 groups,there was significant difference(P<0.05).3.There was no significant difference in fatality rate of patients between 2 groups.Conclusions The parameter of respirator can be adjusted more correctly in mechanical rentilation through monitoring the change of Cdyn,Raw,WOB,OI and P0.1 and it can predict weaning criteria from ventilator.The incidence of ventilated-induced lung injury of AHRF children,the low tide volume ventilation is better than the traditional ventilation.There is no significant difference between the patients with traditional tide volume and those with low tidal volume in the results of improving case fatality rate of AHRF children.