俯卧位通气治疗儿童急性呼吸窘迫综合征的效果及安全性评估

Effect and safety of prone position ventilation in the treatment of acute respiratory distress syndrome in children

摘要:

目的 分析俯卧位通气（PPV）治疗儿童急性呼吸窘迫综合征（ARDS）中的效果及评估其安全性。方法 回顾性分析儿童重症监护室（PICU）采用俯卧位进行呼吸机辅助呼吸的ARDS患儿50例（俯卧位组），根据患儿基线资料进行配对50例非俯卧位进行呼吸机辅助呼吸的ARDS患儿（非俯卧位组），比较两组患儿的吸气峰压（PIP）、呼气末正压（PEEP）、呼吸频率（RR）、吸入氧浓度（FiO2）、血pH值、动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、氧合指数、血氧饱和度（SpO2）、并发症、病死率、住院时间及机械通气时间等指标。结果 治疗后俯卧位组患儿的p H值、PaO2、氧合指数高于治疗前与非俯卧位组（P<0.01）,PaCO2、PEEP、RR、FiO2、呼吸机相关性肺炎（VAP）低于非俯卧位组（P<0.01或0.05），面部水肿发生率高于非俯卧位组（P<0.05）;PICU住院时间与机械通气时间均短于非俯卧位组（P<0.05）。结论 俯卧位通气治疗能够显著改善ARDS患儿的氧合指数，缩短呼吸机使用及PICU住院时间，护理并发症发生率少。

Abstract:

Objective To investigate the effect and safety of prone position ventilation (PPV) in the treatment of acute respiratory distress syndrome (ARDS) in children. Methods Retrospective analysis was performed on 50 ARDS children in the pediatric intensive care unit (PICU) who received ventilator-assisted breathing in prone position (PPV Group), and another 50 ARDS children who received ventilator-assisted breathing in non-prone position (Non-PPV Group) were selected according to the baseline data of the children as control. The two groups were compared in peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), respiratory rate (RR), inhaled oxygen concentration (FiO2), blood pH, partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), oxygenation index, oxygen saturation (SpO2), complications, mortality, hospital stay and duration of mechanical ventilation. Results After treatment, the pH, PaO2 and oxygenation index in the PPV Group were higher than those before treatment and those in Non-PPS Group (P<0.01), while the PaCO2, PEEP, RR, FiO2 and ventilator-associated pneumonia (VAP) in the PPS Group were lower than those in the Non-PPS Group (P<0.01 or 0.05), the incidence of facial edema in the PPS Group was higher than that in the Non-PPS Group (P<0.05), and the duration of mechanical ventilation in the PPS Group was shorter than that in the Non-PPS Group (P<0.05). Conclusion Prone position ventilation can significantly improve oxygenation index, shorten the use of respirator and hospital stay in PICU, and reduce the incidence of nursing complications.