CAJ | 학술논문

目的观察小潮气量通气治疗小儿急性呼吸窘迫综合征(ARDS)的疗效.方法选择本院2008年1月至2011年12月本院PICU收治需支持通气的ARDS患儿44例为研究对象,将患者分为2组,对照组(20例)机械通气采用常规潮气量(10～12 ml/kg)；观察组(24例)机械通气采用小潮气量(6～8 ml/kg).上机后观察两组患儿24、48及72 h氧合改善及血气分析等指标变化,分析机械通气并发症及28 d病死率.结果两组患儿上机前PaO2/FiO2值(104±23.6 vs 112 ±34.7)比较差异无统计学意义(P＞0.05)；上机后24、48及72 h PaO2/Fi02、PaCO2两组比较差异均有统计学意义(t≥2.01,P＜0.05;t ≥2.74,P＜0.01)；观察组气压伤低于对照组(x2 =6.97,P＜0.01)；观察组病死率16.7％(4/24)低于对照组50％(10/20),其差异有统计学意义(x2=5.58,P＜0.05).结论 ARDS患儿采用小潮气量通气,能改善其氧和,且无血液动力学影响,亦可降低机械通气并发症及病死率,其疗效确切,值得临床推广应用.
목적 관찰소조기량통기치료소인급성호흡군박종합정(ARDS)적료효.방법 선택본원2008년1월지2011년12월본원PICU수치수지지통기적ARDS환인44례위연구대상,장환자분위2조,대조조(20례)궤계통기채용상규조기량(10～12 ml/kg)；관찰조(24례)궤계통기채용소조기량(6～8 ml/kg).상궤후관찰량조환인24、48급72 h양합개선급혈기분석등지표변화,분석궤계통기병발증급28 d병사솔.결과 량조환인상궤전PaO2/FiO2치(104±23.6 vs 112 ±34.7)비교차이무통계학의의(P＞0.05)；상궤후24、48급72 h PaO2/Fi02、PaCO2량조비교차이균유통계학의의(t≥2.01,P＜0.05;t ≥2.74,P＜0.01)；관찰조기압상저우대조조(x2 =6.97,P＜0.01)；관찰조병사솔16.7％(4/24)저우대조조50％(10/20),기차이유통계학의의(x2=5.58,P＜0.05).결론 ARDS환인채용소조기량통기,능개선기양화,차무혈액동역학영향,역가강저궤계통기병발증급병사솔,기료효학절,치득림상추엄응용.
Objective To explore the effect of low tidal volume ventilation on the treatment of children with acute respiratory distress syndrome (ARDS).Methods Forty-four hospitalized children with ARDS from Jan 2008 to Dec 2011 at Kunming Children's Hospital were enrolled in this study.The observation group included 24 patients who received the treatment of low tidal volume ventilation (6 ～ 8 ml/kg),while the other 20 patients were in the control group who were given traditional volume ventilation (10 ～ 12 ml/kg).Oxygenation situations and blood gas analysis at 24,48,72 h after ventilation、mechanical ventilation complications,and the mortality in the first 28 days were observed.Results The ratios of PaO2/FiO2 were 104 ±23.6 in observation group and 112 ±34.7 in control group (P ＞0.05).However,after 24,48 and 72 h of ventilation,the ratios of PaO2/FiO2 showed statistical significance (t ≥2.01,P ＜0.05 ; t ≥2.74,P ＜ 0.01).Barotrauma in observation group was significantly lower than that in control group (x2 =6.97,P ＜ 0.01).The mortality (16.7％) of the observation group was significantly lower than that (50％) of the control group (x2 =5.58,P ＜ 0.05).Conclusions Low tidal volume ventilation can reduce complications and improve oxygenation of ARDS patients,and reduce the mortality in ARDS children.The improved rescue technology should be applied for the treatment of children with ARDS.