中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
17期
1347-1349
,共3页
李峥%钱素云%王荃%贾鑫磊%刘珺
李崢%錢素雲%王荃%賈鑫磊%劉珺
리쟁%전소운%왕전%가흠뢰%류군
呼吸道压力释放通气%儿童%急性呼吸窘迫综合征%机械通气
呼吸道壓力釋放通氣%兒童%急性呼吸窘迫綜閤徵%機械通氣
호흡도압력석방통기%인동%급성호흡군박종합정%궤계통기
Airway pressure release ventilation%Child%Acute respiratory distress syndrome%Mechanical ventilation
目的 研究呼吸道压力释放通气(APRV)在治疗儿童重症肺炎并急性呼吸窘迫综合征(ARDS)中的作用.方法 以2011年3月至2014年10月在北京儿童医院儿童重症监护病房(PICU)因重症肺炎并ARDS住院、并应用APRV治疗的10例患儿为研究对象,对比常频通气和应用APRV后第1、4、12、24小时末的呼吸机参数、呼吸道压力变化、镇静评分等,研究APRV在治疗儿童重症肺炎并ARDS的临床效应.结果 应用APRV后各时段高呼吸道压(Phigh)较常频通气呼吸道峰压(Ppeak)或平台压(Pplat)明显降低[(26.00±2.94)cmH2O(1 cmH2O=0.098 kPa)、(24.40±3.34) cmH2O、(23.30± 3.46) cmH2O、(23.00±3.80) cmH2O比(31.80±5.59) cmH2O,P＜0.01];应用APRV后各时段的平均呼吸道压(Pmean)均较常频通气明显升高[(23.00±2.86) cmH2O、(21.69±3.12) cmH2O、(20.89±3.31) cmH2O、(20.46±3.48) cmH2O比(17.50±2.37) cmH2O,P＜0.05];应用APRV后第4小时末、第12小时末、第24小时末吸入氧体积分数(FiO2)较常频通气时明显降低[(73.00±22.39)％、(63.50±20.16)％、(63.00 ±21.11)％比(88.00±15.49)％,P＜0.05];应用APRV后各时段的Ramsay评分较常频通气Ramsay评分减低[(3.90±0.74)分、(2.90±0.88)分、(3.00±1.15)分、(3.50±0.71)分比(4.60±0.52)分,P＜0.05].结论 APRV的Phigh较常频通气Ppeak或Pplat低,Pmean较常频通气高,FiO2较常频通气低,可在较常频通气浅的镇静深度下进行,可能是治疗儿童重症肺炎并ARDS有效的通气方式之一.
目的 研究呼吸道壓力釋放通氣(APRV)在治療兒童重癥肺炎併急性呼吸窘迫綜閤徵(ARDS)中的作用.方法 以2011年3月至2014年10月在北京兒童醫院兒童重癥鑑護病房(PICU)因重癥肺炎併ARDS住院、併應用APRV治療的10例患兒為研究對象,對比常頻通氣和應用APRV後第1、4、12、24小時末的呼吸機參數、呼吸道壓力變化、鎮靜評分等,研究APRV在治療兒童重癥肺炎併ARDS的臨床效應.結果 應用APRV後各時段高呼吸道壓(Phigh)較常頻通氣呼吸道峰壓(Ppeak)或平檯壓(Pplat)明顯降低[(26.00±2.94)cmH2O(1 cmH2O=0.098 kPa)、(24.40±3.34) cmH2O、(23.30± 3.46) cmH2O、(23.00±3.80) cmH2O比(31.80±5.59) cmH2O,P＜0.01];應用APRV後各時段的平均呼吸道壓(Pmean)均較常頻通氣明顯升高[(23.00±2.86) cmH2O、(21.69±3.12) cmH2O、(20.89±3.31) cmH2O、(20.46±3.48) cmH2O比(17.50±2.37) cmH2O,P＜0.05];應用APRV後第4小時末、第12小時末、第24小時末吸入氧體積分數(FiO2)較常頻通氣時明顯降低[(73.00±22.39)％、(63.50±20.16)％、(63.00 ±21.11)％比(88.00±15.49)％,P＜0.05];應用APRV後各時段的Ramsay評分較常頻通氣Ramsay評分減低[(3.90±0.74)分、(2.90±0.88)分、(3.00±1.15)分、(3.50±0.71)分比(4.60±0.52)分,P＜0.05].結論 APRV的Phigh較常頻通氣Ppeak或Pplat低,Pmean較常頻通氣高,FiO2較常頻通氣低,可在較常頻通氣淺的鎮靜深度下進行,可能是治療兒童重癥肺炎併ARDS有效的通氣方式之一.
목적 연구호흡도압력석방통기(APRV)재치료인동중증폐염병급성호흡군박종합정(ARDS)중적작용.방법 이2011년3월지2014년10월재북경인동의원인동중증감호병방(PICU)인중증폐염병ARDS주원、병응용APRV치료적10례환인위연구대상,대비상빈통기화응용APRV후제1、4、12、24소시말적호흡궤삼수、호흡도압력변화、진정평분등,연구APRV재치료인동중증폐염병ARDS적림상효응.결과 응용APRV후각시단고호흡도압(Phigh)교상빈통기호흡도봉압(Ppeak)혹평태압(Pplat)명현강저[(26.00±2.94)cmH2O(1 cmH2O=0.098 kPa)、(24.40±3.34) cmH2O、(23.30± 3.46) cmH2O、(23.00±3.80) cmH2O비(31.80±5.59) cmH2O,P＜0.01];응용APRV후각시단적평균호흡도압(Pmean)균교상빈통기명현승고[(23.00±2.86) cmH2O、(21.69±3.12) cmH2O、(20.89±3.31) cmH2O、(20.46±3.48) cmH2O비(17.50±2.37) cmH2O,P＜0.05];응용APRV후제4소시말、제12소시말、제24소시말흡입양체적분수(FiO2)교상빈통기시명현강저[(73.00±22.39)％、(63.50±20.16)％、(63.00 ±21.11)％비(88.00±15.49)％,P＜0.05];응용APRV후각시단적Ramsay평분교상빈통기Ramsay평분감저[(3.90±0.74)분、(2.90±0.88)분、(3.00±1.15)분、(3.50±0.71)분비(4.60±0.52)분,P＜0.05].결론 APRV적Phigh교상빈통기Ppeak혹Pplat저,Pmean교상빈통기고,FiO2교상빈통기저,가재교상빈통기천적진정심도하진행,가능시치료인동중증폐염병ARDS유효적통기방식지일.
Objective To investigate the effects of airway pressure release ventilation (APRV) in children with severe pneumonia-related acute respiratory distress syndrome(ARDS).Methods Ten children suffering severe pneumonia-related ARDS with APRV were included in Pediatric Intensive Care Unit, Beijing Children's Hospital,Capital Medical University from March 2011 to October 2014.Ventilation variables, changes of airway pressure and Ramsay scores were collected and compared with that in conventional ventilation (CV).Clinical variables were measured at CV before APRV and at 1,4,12,24 hours after transition to APRV.Results High airway pressure(Phigh) at each time point during APRV was significantly lower than peak airway pressure (Ppeak) or plateau airway pressure (Pplat) in CV[(26.00 ±2.94) cmH2O(1 cmH2O =0.098 kPa) ,(24.40 ±3.34) cmH2O,(23.30 ±3.46) cmH2O,(23.00 ± 3.80) cmH2O vs (31.80 ± 5.59) cmH2O, P ＜ 0.01].Mean airway pressure (Pmean) at each time point during APRV was significantly higher than that in CV [(23.00 ± 2.86) cmH2 O, (21.69 ± 3.12) cmH2 O, (20.89 ± 3.31) cmH2 O, (20.46 ± 3.48) cmH2 O vs (17.50 ± 2.37) cmH2 O, P ＜ 0.05].Fraction of inspired oxygen (FiO2) were significantly decreased at 4, 12 and 24 hours after APRV than that in CV [(73.00 ± 22.39) ％, (63.50 ± 20.16) ％, (63.00 ± 21.11) ％ vs (88.00 ± 15.49) ％, P ＜ 0.05].Ramsay scores were significantly decreased at each time point during after APRV than that in CV [(3.90 ± 0.74) scores, (2.90 ± 0.88) scores, (3.00 ± 1.15) scores,(3.50 ± 0.71) scores vs (4.60 ± 0.52) scores, P ＜ 0.05].Conclusions Compared with CV, APRV had a lower Phigh and FiO2 ,a higher Pmean and more shallow sedation.APRV may be an effective ventilation mode in children's severe pneumonia-related ARDS.
