中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
11期
693-696
,共4页
呼气末正压%脓毒性休克%急性呼吸窘迫综合征%婴幼儿
呼氣末正壓%膿毒性休剋%急性呼吸窘迫綜閤徵%嬰幼兒
호기말정압%농독성휴극%급성호흡군박종합정%영유인
Positive end-expiratory pressure%Septic shock%Acute respiratory distress syndrome%Infants
目的 评价不同呼气末正压(positive end-expiratory pressure,PEEP)对脓毒性休克合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)婴幼儿预后的影响.方法 将广西壮族自治区妇幼保健院PICU收治的60例脓毒性休克合并ARDS婴幼儿分为3组,每组20例,分别应用低、中、高三种水平PEEP(3、6、9 cmH2O,l cmH2O=0.098 kPa)进行呼吸机辅助通气,均采用压力控制机械通气模式,小潮气量(6 ～8 ml/kg)通气策略,同时根据美国危重病儿科高级生命支持协会2009年颁布的脓毒性休克指南指导液体复苏.监测3组患儿上机后6、24、48 h氧合指数(OI)、呼吸系统动态顺应性(Cdyn)、心脏指数(CI)的变化并统计每例患儿的液体入/出量,比较3组患儿机械通气时间、PICU住院时间及28 d病死率.结果 机械通气后6h开始,中、高PEEP组OI、Cdyn均明显好转,与低PEEP组比较差异均有统计学意义(P均＜0.01);中、低PEEP组CI明显高于高PEEP组,液体入量少于高PEEP组,差异均有统计学意义(P均＜0.01),3组液体出量比较差异无统计学意义(P＞0.05);中PEEP组呼吸机辅助通气时间[(5.40±0.61)d]、PICU住院时间[(7.00±0.61)d]均短于高、低PEEP两组[(6.23±0.90)d、(7.51±1.09)d;(8.23-±0.90)d、(9.14±1.21)d](P均＜0.01);3组患儿病死率比较差异无统计学意义(P＞0.05).结论 中PEEP能显著改善脓毒性休克合并ARDS患儿的肺功能,缩短机械通气时间,对血流动力学无严重不良影响.
目的 評價不同呼氣末正壓(positive end-expiratory pressure,PEEP)對膿毒性休剋閤併急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)嬰幼兒預後的影響.方法 將廣西壯族自治區婦幼保健院PICU收治的60例膿毒性休剋閤併ARDS嬰幼兒分為3組,每組20例,分彆應用低、中、高三種水平PEEP(3、6、9 cmH2O,l cmH2O=0.098 kPa)進行呼吸機輔助通氣,均採用壓力控製機械通氣模式,小潮氣量(6 ～8 ml/kg)通氣策略,同時根據美國危重病兒科高級生命支持協會2009年頒佈的膿毒性休剋指南指導液體複囌.鑑測3組患兒上機後6、24、48 h氧閤指數(OI)、呼吸繫統動態順應性(Cdyn)、心髒指數(CI)的變化併統計每例患兒的液體入/齣量,比較3組患兒機械通氣時間、PICU住院時間及28 d病死率.結果 機械通氣後6h開始,中、高PEEP組OI、Cdyn均明顯好轉,與低PEEP組比較差異均有統計學意義(P均＜0.01);中、低PEEP組CI明顯高于高PEEP組,液體入量少于高PEEP組,差異均有統計學意義(P均＜0.01),3組液體齣量比較差異無統計學意義(P＞0.05);中PEEP組呼吸機輔助通氣時間[(5.40±0.61)d]、PICU住院時間[(7.00±0.61)d]均短于高、低PEEP兩組[(6.23±0.90)d、(7.51±1.09)d;(8.23-±0.90)d、(9.14±1.21)d](P均＜0.01);3組患兒病死率比較差異無統計學意義(P＞0.05).結論 中PEEP能顯著改善膿毒性休剋閤併ARDS患兒的肺功能,縮短機械通氣時間,對血流動力學無嚴重不良影響.
목적 평개불동호기말정압(positive end-expiratory pressure,PEEP)대농독성휴극합병급성호흡군박종합정(acute respiratory distress syndrome,ARDS)영유인예후적영향.방법 장엄서장족자치구부유보건원PICU수치적60례농독성휴극합병ARDS영유인분위3조,매조20례,분별응용저、중、고삼충수평PEEP(3、6、9 cmH2O,l cmH2O=0.098 kPa)진행호흡궤보조통기,균채용압력공제궤계통기모식,소조기량(6 ～8 ml/kg)통기책략,동시근거미국위중병인과고급생명지지협회2009년반포적농독성휴극지남지도액체복소.감측3조환인상궤후6、24、48 h양합지수(OI)、호흡계통동태순응성(Cdyn)、심장지수(CI)적변화병통계매례환인적액체입/출량,비교3조환인궤계통기시간、PICU주원시간급28 d병사솔.결과 궤계통기후6h개시,중、고PEEP조OI、Cdyn균명현호전,여저PEEP조비교차이균유통계학의의(P균＜0.01);중、저PEEP조CI명현고우고PEEP조,액체입량소우고PEEP조,차이균유통계학의의(P균＜0.01),3조액체출량비교차이무통계학의의(P＞0.05);중PEEP조호흡궤보조통기시간[(5.40±0.61)d]、PICU주원시간[(7.00±0.61)d]균단우고、저PEEP량조[(6.23±0.90)d、(7.51±1.09)d;(8.23-±0.90)d、(9.14±1.21)d](P균＜0.01);3조환인병사솔비교차이무통계학의의(P＞0.05).결론 중PEEP능현저개선농독성휴극합병ARDS환인적폐공능,축단궤계통기시간,대혈류동역학무엄중불량영향.
Objective To evaluate the influence of different positive end-expiratory pressure (PEEP) on prognosis in infants with septic shock and acute respiratory distress syndrome(ARDS).Methods Sixty infants who were diagnosed with septic shock and ARDS in PICU of Guangxi Maternity and Child Health Hospital were enrolled,which were randomly divided into low PEEP(3 cmH2O,1 cmH2O =0.098 kPa) group,medium PEEP (6 cmH2 O) group and high PEEP (9 cmH2O) group,with 20 cases in each group.All patients received pressure control ventilation mode and small tidal volume (6 ～ 8 ml/kg) strategy,meanwhile implemented liquid recovery according to the septic shock guidelines (2009)enacted by the American Association of Pediatric Advanced Life Support (PALS).The changes of O1,Cdyn and CI before and 6 h,24 h and 48 h after the experiment were monitored,fluid intake/output of all infants were counted.The lengths of mechanical ventilation,hospital stays in PICU and 28-day mortality were compared.Results 6 h,24 h and 48 h after mechanical ventilation,the changes of OI,Cdyn in medium PEEP group and high PEEP group were better than those of low PEEP group respectively (P ＜ 0.01,respectively).The values of CI in low PEEP group and medium PEEP group were higher than that of high PEEP group respectively(P ＜0.01,respectively).There were no significant differences in urine output among three groups (P ＞ 0.05).The lengths of mechanical ventilation and hospital stays in PICU in medium PEEP group [(5.40 ± 0.61) d,(7.00±0.61) d]were shorter than those of the high PEEP and low PEEP groups [(6.23 ±0.90)d,(7.51 ± 1.09) d; (8.23 ± 0.90) d,(9.14 ± 1.21) d] (P ＜ 0.01,respectively).There were no significant differences in mortality among three groups (P ＞ 0.05).Conclusion Medium PEEP can significantly improve lung function of infants who are diagnosed with septic shock and ARDS,shorten the lengths of mechanical ventilation,and has no serious adverse effect on hemodynamics.
