最佳呼吸系统动态顺应性设定呼气末正压对急性呼吸窘迫综合征婴幼儿预后的影响
최가호흡계통동태순응성설정호기말정압대급성호흡군박종합정영유인예후적영향
Impact of optimal respiratory system dynamic compliance strategy for titrating positive end-expiratory pressure on the prognosis of acute respiratory distress syndrome in infants
  • 万方数据
    中华实用儿科临床杂志 중화실용인과림상잡지
    Journal of Applied Clinical Pediatrics
    2015年 6期 445-448 ,共4页

    谢友军%莫武桂%韦跃%韦蓉%唐育鹏%傅君%卢功志

    사우군%막무계%위약%위용%당육붕%부군%로공지

    婴幼儿%呼气末正压%呼吸系统动态顺应性%急性呼吸窘迫综合征 嬰幼兒%呼氣末正壓%呼吸繫統動態順應性%急性呼吸窘迫綜閤徵
    영유인%호기말정압%호흡계통동태순응성%급성호흡군박종합정
    Infant%Positive end-expiratory pressure%Respiratory system dynamic compliance%Acute respiratory distress syndrome
    目的 探讨滴定最佳呼吸系统动态顺应性(Cdyn)设定呼气末正压(PEEP)对急性呼吸窘迫综合征(ARDS)婴幼儿预后的影响.方法 将广西壮族自治区妇幼保健院儿童重症监护病房(PICU)收治的30例ARDS婴幼儿按信封法随机分为对照组和治疗组,每组15例,分别使用美国ARDS协作网预先设定好的PEEP/吸入氧浓度(FiO2)对照表和滴定最佳Cdyn的方法设定PEEP,均采用压力控制通气(PCV)模式,小潮气量(7mL/kg)通气策略,监测2组患儿试验前及试验后呼吸力学、血流动力学、炎性因子等指标的变化,比较2组患儿机械通气时间、PICU住院时间及28 d病死率.结果 1.2组患儿性别、年龄、危重病例评分等一般情况比较差异无统计学意义(P均＞0.05).2.根据PEEP/FiO2对照表设定的PEEP值明显低于滴定最佳Cdyn方法确定的PEEP值[(6.4±1.4)cmH2O(1 cmH2O =0.098 kPa)比(9.9±1.6)cmH2O,P＜0.01].3.2组Cdyn、氧合指数(Ol)均有好转,治疗组好转程度较对照组明显[Cdyn试验后2 h:(0.39±0.03) mL/(cmH2O·kg)比(0.36±0.03) mL/(cmH2O·kg),P ＜0.05;24 h:(0.40 ±0.03) mL/(cmH2O·kg)比(0.38±0.03)mL/(cmH2O·kg),P＜0.05;48 h:(0.43±0.02) mL/(cmH2O·kg)比(0.40±0.02) mL/(cmH2O·kg),P＜0.01;OI试验后24 h:(20.07±2.12) cmH2O/mmHg(1 mmHg=0.133 kPa)比(21.94 ±2.05) cmH2O/mmHg,P＜ 0.05;48 h:(17.51±1.64) cmH2O/mmHg比(19.82±2.07) cmH2O/mmHg,P＜0.01];试验前后2组心率(HR)、平均动脉压(MAP)、心脏指数(CI)等比较差异均无统计学意义(P＞0.05).4.2组白细胞介素-6(IL-6)均呈进行性降低,治疗组降低程度较对照组更为明显[试验后24 h:(84.58±9.11) ng/L比(93.18 ±9.27)ng/L,P＜0.05;48 h:(76.67 ±9.23) ng/L比(90.10 ±9.42) ng/L,P＜0.01].5.治疗组机械通气时间、PICU住院时间均明显短于对照组[机械通气时间:(6.62±1.26)d比(8.06±1.44)d,P＜0.05;PICU住院时间:(8.12±1.31)d比(9.53±1.42)d,P＜0.05];2组患者均未有气压伤发生,病死率比较差异无统计学意义(P＞0.05).结论 滴定最佳Cdyn方法设定最佳PEEP能明显改善ARDS婴幼儿的呼吸力学,缩短机械通气时间,同时对血流动力学无严重不良影响.
    목적 탐토적정최가호흡계통동태순응성(Cdyn)설정호기말정압(PEEP)대급성호흡군박종합정(ARDS)영유인예후적영향.방법 장엄서장족자치구부유보건원인동중증감호병방(PICU)수치적30례ARDS영유인안신봉법수궤분위대조조화치료조,매조15례,분별사용미국ARDS협작망예선설정호적PEEP/흡입양농도(FiO2)대조표화적정최가Cdyn적방법설정PEEP,균채용압력공제통기(PCV)모식,소조기량(7mL/kg)통기책략,감측2조환인시험전급시험후호흡역학、혈류동역학、염성인자등지표적변화,비교2조환인궤계통기시간、PICU주원시간급28 d병사솔.결과 1.2조환인성별、년령、위중병례평분등일반정황비교차이무통계학의의(P균＞0.05).2.근거PEEP/FiO2대조표설정적PEEP치명현저우적정최가Cdyn방법학정적PEEP치[(6.4±1.4)cmH2O(1 cmH2O =0.098 kPa)비(9.9±1.6)cmH2O,P＜0.01].3.2조Cdyn、양합지수(Ol)균유호전,치료조호전정도교대조조명현[Cdyn시험후2 h:(0.39±0.03) mL/(cmH2O·kg)비(0.36±0.03) mL/(cmH2O·kg),P ＜0.05;24 h:(0.40 ±0.03) mL/(cmH2O·kg)비(0.38±0.03)mL/(cmH2O·kg),P＜0.05;48 h:(0.43±0.02) mL/(cmH2O·kg)비(0.40±0.02) mL/(cmH2O·kg),P＜0.01;OI시험후24 h:(20.07±2.12) cmH2O/mmHg(1 mmHg=0.133 kPa)비(21.94 ±2.05) cmH2O/mmHg,P＜ 0.05;48 h:(17.51±1.64) cmH2O/mmHg비(19.82±2.07) cmH2O/mmHg,P＜0.01];시험전후2조심솔(HR)、평균동맥압(MAP)、심장지수(CI)등비교차이균무통계학의의(P＞0.05).4.2조백세포개소-6(IL-6)균정진행성강저,치료조강저정도교대조조경위명현[시험후24 h:(84.58±9.11) ng/L비(93.18 ±9.27)ng/L,P＜0.05;48 h:(76.67 ±9.23) ng/L비(90.10 ±9.42) ng/L,P＜0.01].5.치료조궤계통기시간、PICU주원시간균명현단우대조조[궤계통기시간:(6.62±1.26)d비(8.06±1.44)d,P＜0.05;PICU주원시간:(8.12±1.31)d비(9.53±1.42)d,P＜0.05];2조환자균미유기압상발생,병사솔비교차이무통계학의의(P＞0.05).결론 적정최가Cdyn방법설정최가PEEP능명현개선ARDS영유인적호흡역학,축단궤계통기시간,동시대혈류동역학무엄중불량영향.
    Objective To investigate the impact of optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP)on the prognosis of acute respiratory distress syndrome (ARDS) in infants.Methods A total of 30 patients with ARDS admitted in Pediatric Intensive Care Unit (PICU) of Guangxi Maternity and Child Health Hospital were divided into 2 groups randomly (n =15).PEEP was set in the control group according to PEEP/FiO2 in American ARDS collaboration while optimal Cdyn was for the treatment group.Pressure control ventilation(PCV) mode and small tidal volume(7 mL/kg)strategy were taken.Respiratory mechanics,hemodynamics and inflammatory cytokines were monitored in each group before and after experiment.The time of assisted ventilation,and the hospital stay in PICU and 28-day mortality were compared.Results (1) There was no significant differences in gender,age and severity of disease between the 2 groups (all P ＞ 0.05).(2) The optimal PEEP of the control group was significant lower than that of the treatment group[(6.4 ± 1.4) cmH2O vs (9.9-± 1.6) cmH2O,P ＜ 0.01].(3) Cdyn and oxygenation index(OI) in 2 groups were all improved,and the degree of improvement in the treatment group was significantly better than that of the control group [Cdyn after the experiment at 2 h:(0.39 ± 0.03) mL/(cmH2O·kg) vs (0.36 ±0.03) mL/(cmH2O · kg),P＜0.05; 24 h:(0.40±0.03) mL/(cmH2O · kg) vs (0.38±0.03) mL/(cmH2O · kg),P ＜0.05; 48 h:(0.43 ±0.02) mL/(cmH2O · kg) vs (0.40 ± 0.02) mL/(cmH2 O · kg),P ＜ 0.01 ; OI after the experiment at 24 h:(20.07 ± 2.12) cmH2O/mmHg vs (21.94 ± 2.05),P ＜0.05 ; 48 h:(17.51 ± 1.64) cmH2O/mmHgvs (19.82 ± 2.07) cmH2O/mmHg,P ＜ 0.01] ; There were no significant differences in heart rate(HR),mean aerial pressure(MAP),cardiac index (CI) before and after the experiment (all P ＞ 0.05).(4) Interleukin-6 (IL-6) in two groups all decreased gradually,and the decrease in treatment group was more obvious than that of control group after the experiment at 24 h:(84.58-± 9.11) ng/L vs (93.18 ± 9.27) ng/L,P ＜ 0.05 ; 48 h:(76.67 ± 9.23) ng/L vs (90.10-± 9.42) ng/L,P ＜ 0.01.(5) The lengths of assisted ventilation and the hospital stay in PICU of the treatment group were significantly less than that of the control group [length of assisted ventilation:(6.62 ± 1.26) d vs (8.06-± 1.44) d ; the hospital stay in PICU:(8.12 ± 1.31) d vs (9.53 ±1.42) d,all P ＜0.05].There had no barotrauma and the mortality was not distinct between the two groups(P ＞ 0.05).Conclusions Optimal Cdyn method for titrating PEEP improves respiratory mechanics of ARDS obviously,shortens the time of assisted ventilation,and has no serious adverse effect on hemodynamics.
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