ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2017, Vol. 9 ›› Issue (6): 489-491.doi: 10.3969/j.issn.1674-3865.2017.06.009

• 临床研究 • 上一篇    下一篇

肺保护性通气策略对小儿急性呼吸窘迫综合征治疗的影响

臧平，罗兰   

  1. 410007 长沙，湖南省儿童医院急救中心
  • 出版日期:2017-12-25 发布日期:2018-11-19
  • 通讯作者: 罗兰，E-mail:335129775@qq.com
  • 作者简介:臧平（1982-），男，主治医师。研究方向：小儿急救

Effect of lung protective ventilation strategy on the treatment for children with acute respiratory distress syndrome

ZANG Ping,LUO Lan.   

  1. Hunan Children's Hospital,Changsha 410007，China
  • Online:2017-12-25 Published:2018-11-19

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摘要：
目的
观察肺保护性通气策略对小儿急性呼吸窘迫综合征治疗的影响。
方法
2014年1月至2016年1月湖南省儿童医院急救中心收治急性呼吸窘迫综合征患儿80例为研究对象，随机分为对照组和观察组各40例。对照组患儿采用传统机械通气策略，观察组采用肺保护性通气策略，其他治疗相同。观察治疗后的呼吸机参数主要包含吸气峰压、呼吸末正压、平均气道压、吸入氧浓度、呼吸频率；动脉血气分析；并发症情况。
结果
观察组患儿的吸气峰压、平均气道压、吸入氧浓度的参数值显著低于对照组，呼吸末正压、呼吸频率参数值显著高于对照组，差异有统计学意义（P<0.05）。观察组患儿pH、PaO2显著低于对照组，PCO2显著高于对照组，差异有统计学意义（P<0.05）。观察组患儿经过治疗后呼吸机肺损伤、脑室内出血、动脉导管开放发生率比较差异无统计学意义（P>0.05）；观察组不良反应发生率低于对照组，差异有统计学意义（P<0.05）。
结论
小儿急性呼吸窘迫综合征治疗中应用肺保护性通气策略能够优化呼吸机参数，改善患儿动脉血气值，降低不良反应发生率，具有重要的临床价值和应用意义。

关键词: 急性呼吸窘迫综合征, 肺保护性通气策略, 机械通气, 儿童

Abstract:
Objective
To observe the effect of lung protective ventilation strategy on the treatment for children with acute respiratory distress syndrome.
Methods
From January 2014 to January 2016,80 cases of acute respiratory distress syndrome in Hunan Children's Hospital were randomly divided into the control group and the observation group,40 cases in each group. The control group received traditional mechanical ventilation strategy,and the observation group adopted the lung protective ventilation strategy,the other treatments being the same. The indicators were observed after treatment,including inspiratory peak pressure,positive end expiratory pressure,mean airway pressure,inhaled oxygen concentration,respiratory rate,arterial blood gas analysis,and complications.
Results
The peak inspiratory pressure,mean airway pressure and suction parameters of oxygen concentration in observation group were significantly lower than those in control group,while positive end expiratory pressure and frequency of respiration parameters were significantly higher,the difference being statistically significant(P<0.05). The pH and PaO2 of the observation group were significantly lower than those of the control group,and the PCO2 was significantly higher than that of the control group,the difference being statistically significant (P<0.05).The incidence rate of ventilator induced lung injury,intraventricular hemorrhage and patent ductus arteriosus had no statistical difference after treatment in observation group(P>0.05),while the incidence rate of adverse reactions was lower than that of control group,the difference being statistically significant(P<0.05).
Conclusion
In the treatment of children with acute respiratory distress syndrome,the lung protective ventilation strategy can optimize the ventilator parameters,improve the arterial blood gas value of children,and reduce the incidence of adverse reactions,which has important clinical value and application significance.

Key words: Acute respiratory distress syndrome, Lung protective ventilation strategy, Mechanical ventilation, Children