不同潮气量机械通气在危重患儿呼吸衰竭中的临床应用研究

目的 探讨小潮气量和传统潮气量机械通气在危重患儿急性呼吸衰竭治疗中的安全差异性.方法 将80例急性呼吸衰竭患儿分为传统潮气量通气组30例、小潮气量通气组50例,根据潮气量调整呼气末正压(PEEP)、吸气峰压(PIP)、平均气道压(MAP),监测肺动态顺应性(Cdyn)、呼吸功(Wobv)、气道阻力(Rrs)、气道闭合压(P0.1)、肺泡气-动脉血氧分压差(PA-aO2)、氧合指数(OI)、血气分析等指标的变化,观察患儿氧合改善情况、机械通气并发症的发生、撤机情况以及患儿的转归情况.结果(1)小潮气量机械通气组与传统潮气量机械通气组患儿Cdyn、Rrs在上机第1、3天,Wobv在上机第3、5天,P0.1在上机第5、7天,PEEP、PIP、MAP在上机第0、1、3天比较差异有统计学意义(P＜0.05).小潮气量通气24h氧合改善较传统潮气量通气明显,差异有统计学意义.(2)Wobv、P0.1对撤机有指导意义,两组比较差异无统计学意义(P＞0.05).(3)两组比较,不同潮气量通气治疗AHRF患儿出现气压伤情况的差异有显著性(P＜0.05)；危重患儿的病死率无明显差异(P＞0.05).结论 Cdyn、Rrs、Wobv、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的情况,从而及时调整呼吸机参数并判断撤机的时机.小潮气量通气在降低AHRF患儿病死率方面并不优于传统潮气量通气；但在气压伤方面,小潮气量通气优于传统潮气量,更为安全.

Application study on the lung protective ventilation strategies of low tidal volume in children with acute respiratory failure

Objective To study differences of the therapy of curative effect between low tide volume ventilation and the traditional ventilation in acute hypoxemic respiratory failure(AHRF) of children and assess the curative effect of small tide volume ventilatory strategy. Methods 133 patients with acute respiratory failure of low oxygen children into traditional tide volume ventilation group of 32,small tide volume ventilation group 101 cases,then monitoring Cdyn、Wobv、P0.1、PA-a02.Blood gas analysis and lactic acid clearance rate.To observe the oxygenation、complication、 removing ventilator and prognosis of the critical cases. Results 1、Low tide volume mechanical ventilation group and the traditional one were compared: Cdyn in the 1,3 day;Wobv in the 3,7 day;P0.1 in the3,7day,OI in the 1,3,7 day,difference has statistically significant(P<0.05).2、Compare lactic acid clearance and rate of ventilator associated lung injury between the two groups,difference has statistically significant(P<0.05).3、It is necessary to make a decision of weaning by Wobv and P0.1.4、To compare the case fatality rate of AHRF children of two group,No significant difference was found,P>0.05. Conclusion 1、Cdyn,Wobv,OI,P0.1,judging the children pulmonary disease and the timing of ventilator weaning.2、For lactic acid clearance and the incidence of ventilated-induced lung injury(VILI) of AHRF children,the small tide volume ventilation is better than the traditional.3、No significant difference was found between the patients with high tidal volume and those with low tidal volume in the results of improving case fatality rate of AHRF children,and still need to further research.