中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2009年
3期
222-224
,共3页
急性呼吸窘迫综合征%肺保护性通气%儿童
急性呼吸窘迫綜閤徵%肺保護性通氣%兒童
급성호흡군박종합정%폐보호성통기%인동
Acute respiratory distress syndrome%Lung protective ventilation%Children
目的 探讨肺保护性通气策略在治疗儿童急性呼吸窘迫综合征中的临床应用价值.方法 对1999年1月至2007年12月上海儿童医学中心PICU收治的43例急性呼吸窘迫综合征患儿的临床资料进行回顾性分析.根据机械通气模式的不同分为肺保护性通气组(A组)和传统通气组(B组).A组采用肺保护性通气模式,潮气量6～7 ml/kg,吸气峰压≤30 cm H2O(1 cm H2O=0.133 kPa),应用相对较高的呼气末正压(PEEP),调节吸人氧分数(FiO2)及PEEP以维持经皮血氧饱和度(SpO2)高于90%.B组采用传统通气模式,潮气量8～12 ml/kg,PEEP 2～6 cm H2O,调节FiO2以维持SpO2高于90%.观察2组潮气量、PEEP、动脉血气、病死率及入PICU 28 d内自主呼吸天数.结果 A组潮气量(7.09±1.66)ml/kg,PEEP(7.15±2.08)cm H2O;B组潮气量(9.82±2.31)ml/kg,PEEP(5.40±1.84)cm H2O;A组潮气量较B组显著降低(P=0.001),PEEP较B组显著升高(P=0.021).A组病死率30.3%,自主呼吸天数(10.88±8.84)d;B组病死率60.0%,自主呼吸天数(8.40±10.86)d;两组在病死率与自主呼吸天数上差异无显著性(P＞0.05).结论 肺保护性通气策略治疗儿童急性呼吸窘迫综合征的效果可能优于传统通气模式,但确定结论尚需进一步进行前瞻性临床研究.
目的 探討肺保護性通氣策略在治療兒童急性呼吸窘迫綜閤徵中的臨床應用價值.方法 對1999年1月至2007年12月上海兒童醫學中心PICU收治的43例急性呼吸窘迫綜閤徵患兒的臨床資料進行迴顧性分析.根據機械通氣模式的不同分為肺保護性通氣組(A組)和傳統通氣組(B組).A組採用肺保護性通氣模式,潮氣量6～7 ml/kg,吸氣峰壓≤30 cm H2O(1 cm H2O=0.133 kPa),應用相對較高的呼氣末正壓(PEEP),調節吸人氧分數(FiO2)及PEEP以維持經皮血氧飽和度(SpO2)高于90%.B組採用傳統通氣模式,潮氣量8～12 ml/kg,PEEP 2～6 cm H2O,調節FiO2以維持SpO2高于90%.觀察2組潮氣量、PEEP、動脈血氣、病死率及入PICU 28 d內自主呼吸天數.結果 A組潮氣量(7.09±1.66)ml/kg,PEEP(7.15±2.08)cm H2O;B組潮氣量(9.82±2.31)ml/kg,PEEP(5.40±1.84)cm H2O;A組潮氣量較B組顯著降低(P=0.001),PEEP較B組顯著升高(P=0.021).A組病死率30.3%,自主呼吸天數(10.88±8.84)d;B組病死率60.0%,自主呼吸天數(8.40±10.86)d;兩組在病死率與自主呼吸天數上差異無顯著性(P＞0.05).結論 肺保護性通氣策略治療兒童急性呼吸窘迫綜閤徵的效果可能優于傳統通氣模式,但確定結論尚需進一步進行前瞻性臨床研究.
목적 탐토폐보호성통기책략재치료인동급성호흡군박종합정중적림상응용개치.방법 대1999년1월지2007년12월상해인동의학중심PICU수치적43례급성호흡군박종합정환인적림상자료진행회고성분석.근거궤계통기모식적불동분위폐보호성통기조(A조)화전통통기조(B조).A조채용폐보호성통기모식,조기량6～7 ml/kg,흡기봉압≤30 cm H2O(1 cm H2O=0.133 kPa),응용상대교고적호기말정압(PEEP),조절흡인양분수(FiO2)급PEEP이유지경피혈양포화도(SpO2)고우90%.B조채용전통통기모식,조기량8～12 ml/kg,PEEP 2～6 cm H2O,조절FiO2이유지SpO2고우90%.관찰2조조기량、PEEP、동맥혈기、병사솔급입PICU 28 d내자주호흡천수.결과 A조조기량(7.09±1.66)ml/kg,PEEP(7.15±2.08)cm H2O;B조조기량(9.82±2.31)ml/kg,PEEP(5.40±1.84)cm H2O;A조조기량교B조현저강저(P=0.001),PEEP교B조현저승고(P=0.021).A조병사솔30.3%,자주호흡천수(10.88±8.84)d;B조병사솔60.0%,자주호흡천수(8.40±10.86)d;량조재병사솔여자주호흡천수상차이무현저성(P＞0.05).결론 폐보호성통기책략치료인동급성호흡군박종합정적효과가능우우전통통기모식,단학정결론상수진일보진행전첨성림상연구.
Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.
