摘要
目的评价俯卧位机械通气(PPV)及不同翻身时间对急性呼吸窘迫综合征(ARDS)患儿肺动态顺应性与安全性的影响。方法采用前瞻性研究方法选取2023年5月至2024年3月南阳市中心医院收治的98例ARDS患儿作为研究对象,依据入院序号分成A组(单号)和B组(双号)各49例。两组患儿均进行PPV,A组患儿翻身时间为俯卧3 h—平卧2 h—俯卧3 h,B组患儿为俯卧2 h—平卧2 h—俯卧2 h—平卧2 h—俯卧2 h,干预时间为3 d。比较两组患儿干预前、干预3 d的潮气量(VT)、肺顺应性、中心静脉压(CVP)、平均动脉压(MAP)、心输出指数(CI)、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、氧合指数,同时比较两组患儿的并发症发生率和患儿家属对本次方案的满意度。结果两组患儿干预后的VT、肺顺应性较干预前提高,且A组患儿干预后的肺顺应性为(39.56±5.68)m L/cmH_(2)O,明显高于B组的(35.61±5.82)m L/cmH_(2)O,差异均有统计学意义(P<0.05),但两组患儿干预后的VT比较差异无统计学意义(P>0.05);两组患儿干预前后的CVP、MAP、CI比较差异均无统计学意义(P>0.05);干预后,A组患儿的PaCO_(2)和PaO_(2)分别为(35.89±3.78)mmHg、(89.46±1.86)mmHg,B组分别为(37.41±4.69)mm Hg、(88.96±1.67)mmHg,两组患儿干预后的PaCO_(2)较干预前降低,PaO_(2)较干预前增高,差异均有统计学意义(P<0.05),但两组患儿干预后的PaCO_(2)和PaO_(2)比较差异均无统计学意义(P>0.05);A组患儿干预后的氧合指数为(268.43±42.58)mm Hg,明显高于B组的(251.94±30.06)mm Hg,差异有统计学意义(P<0.05);A组患儿的并发症总发生率为8.16%,略低于B组的12.24%,但差异无统计学意义(P>0.05);A组患儿家属对本次方案的满意率为97.96%,明显高于B组的83.67%,差异有统计学意义(P<0.05)。结论在PPV治疗中,翻身时间设定为俯卧3 h—平卧2 h—俯卧3 h能更有效提高ARDS患儿的肺顺应性,改善氧合指数,并发症发生率低,安全性高。
Objective To investigate the effects of prone position ventilation(PPV)and different turning inter-vals on the dynamic pulmonary compliance and safety in children with acute respiratory distress syndrome(ARDS).Methods A prospective research method was used to select 98 pediatric patients with ARDS admitted to Nanyang City Central Hospital from May 2023 to March 2024 as the study subjects.They were divided into group A(odd numbers)and group B(even numbers),with 49 patients in each group.Both groups of children underwent PPV.For group A,the turning schedule was prone for 3 hs-supine for 2 hs-prone for another 3 hs.For group B,the schedule was prone for 2 hs-supine for 2 hs-prone for 2 hs supine for 2h prone for 2 hs.The intervention lasted for 3 days.The tidal volume(VT),pulmonary compliance,central venous pressure(CVP),mean arterial pressure(MAP),cardiac index(CI),partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),and oxygenation index were compared between the two groups before and after the 3-day intervention.Additionally,the incidence of complications and the satisfaction level of the children's family with the treatment plan were also compared between the two groups.Results After the in-tervention,the VT and lung compliance in both groups were improved.The lung compliance of group A after interven-tion was(39.56±5.68)mL/cmH_(2)O(1 cmH2O=0.098 kPa),which was significantly higher than(35.61±5.82)mL/cmH_(2)O of group B(P<0.05).However,there was no statistically significant difference in VT between the two groups after inter-vention(P>0.05).There was no statistically significant difference in CVP,MAP,and CI between the two groups before and after intervention(P>0.05).After intervention,the PaCO_(2)and PaO_(2)in group A were(35.89±3.78)mmHg(1 mmHg=0.133 kPa)and(89.46±1.86)mmHg,respectively.In group B,they were(37.41±4.69)mmHg and(88.96±1.67)mmHg,respectively.Both groups showed a statistically significant decrease in PaCO_(2)and an increase in PaO_(2)compared to those be-fore the intervention(P<0.05),but there was no statistically significant difference in PaCO_(2)and PaO_(2)between the two groups after the intervention(P>0.05).After the intervention,the oxygenation index of group A was(268.43±42.58)mmHg,which was significantly higher than(251.94±30.06)mmHg of group B(P<0.05).The overall incidence of complications in group A was 8.16%,slightly lower than 12.24%in group B(P>0.05).The treatment program of satisfaction rate of the children's family in group A was 97.96%,significantly higher than 83.67%in group B(P<0.05).Conclusion In PPV treatment,setting the turning schedule to prone for 3 hs-supine for 2 hs-prone for another 3 hs can more effectively im-prove pulmonary compliance and oxygenation index in ARDS children,while maintaining a low complication rate and high safety.
作者
侯海燕
马文伟
李万桢
刘麦叶
杨若燕
石岩
叶雨
殷雪
HOU Hai-yan;MA Wen-wei;LI Wan-zhen;LIU Mai-ye;YANG Ruo-yan;SHI Yan;YE Yu;YIN Xue(Pediatric Intensive Care Unit,Nanyang Central Hospital,Nanyang 473000,Henan,CHINA;Department of CT Intervention,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan,CHINA)
出处
《海南医学》
2025年第13期1962-1966,共5页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20191453)。
关键词
急性呼吸窘迫综合征
俯卧位机械通气
翻身时间
肺顺应性
并发症
Acute respiratory distress syndrome
Prone position ventilation
Turning schedule
Lung compli-ance
Complication
