小潮气量联合肺复张在重症肺炎肺损伤患儿中应用.docVIP

小潮气量联合肺复张在重症肺炎肺损伤患儿中应用 　　【摘要】 目的：观察小潮气量联合肺复张策略（RM）治疗重症肺炎肺损伤患儿的临床有效性及安全性。方法：选取2013年5月-2015年7月本院PICU救治的接受机械通气的42例重症肺炎并肺损伤的患儿作为研究对象，按照随机数字表法将其分为试验组和对照组，每组21例。试验组在入院24 h内给予小潮气量（VT：6～8 mL/kg）机械通气并RM；对照组给予机械通气（VT：8～10 mL/kg）但不进行RM。比较分析两组患儿通气前后血流动力学、呼吸力学、血气变化、机械通气时间、吸氧时间、住院时间、撤机成功率及并发症发生率。结果：试验组21例患儿在小潮气量基础上共进行肺复张操作73例次，RM后5、15、60 min的PIP、R、PEEP、FiO2、Paw均明显低于RM前水平（P0.05）。两组血气分析较通气前均明显改善（P0.05）；两组通气后的PaO2/FiO2、Cdyn、Wobv比较差异均有统计学意义（P0.05）。试验组的机械通气时间、吸氧时间和住院时间均明显短于对照组，并发症发生率明显低于对照组，差异均有统计学意义（P0.05）。结论：小潮气量联合RM治疗重症肺炎肺损伤患儿安全、有效，值得临床推广。 　　【关键词】 重症肺炎； 肺损伤； 肺复张； 潮气量； 儿童 　　【Abstract】 Objective：To observe the effectiveness and safety of low tidal volume combined with lung recruitment maneuver（RM） in the treatment of infantile severe pneumonia complicated by acute lung injury（ALI）.Method：42 children with infantile severe pneumonia complicated by ALI who received mechanical ventilation in the PICU of our hospital from May 2013 to July 2015 were selected as the research objects，and they were randomly divided into the experimental group and the control group，21 cases in each group.The experimental group was given low tidal volume（VT：6-8 mL/kg） respiratory support and RM within 24 hours after admission.The control group was given mechanical ventilation（VT：8-10 mL/kg） and not for RM in the treatment.The hemodynamic parameters，respiratory mechanics，blood gas changes，mechanical ventilation time，oxygen inhalation time，hospitalization time，the success rate of discontinuance of mechanical and complication rate between the two groups before and after ventilation were compared and analyzed.Result：Lung recruitment maneuver was performed for 73 times in 21 children of the experimental group on the basis of low tidal volume，PIP，R，PEEP，FiO2，Paw after RM for 5，15，60 min were all significantly lower than before RM（P0.05）.Compared with before ventilation，the blood gas analysis of the two groups after ventilation were improved（P 　　【Key words】 Severe pneumonia； Lung injury； Lung recruitment maneuver