小儿急性肺损伤的呼吸功能与炎症的研究  

Study of Pulmonary Function and Inflammation in Pediatric Acute Lung Injury

作　　者：杨镒宇[1] 曾其毅[1] 洪婕[1] 陶建平[1] 张剑珲[1] 曾萍[1] 吴艳兰[1] 谢志伟[1] 

机构地区：[1]广州市儿童医院PICU,510120

出　　处：《岭南急诊医学杂志》2007年第2期81-82,85,共3页Lingnan Journal of Emergency Medicine

基　　金：广东省中医药局科研课题(1050064);广州市中医药中西医结合科研课题(2005A026);广东省卫生厅基金资助(A2001579);广东省自然科学基金资助(2000-261);广州市科技局科技攻关计划基金资助(2003Z2-E0181)

摘　　要：目的:探讨儿科急性肺损伤(ALI)的病理生理和发病机制。方法:比较小儿ALI与呼吸功能正常儿的呼吸功能与炎症因子的变化。结果:(1)ALI患儿血气分析显示氧合或通气功能不同程度的恶化。氧合功能(PaO2/FiO2)下降有47例;指标PaCO2上升有27例。(2)机械通气所需气道峰压(PIP)和呼气末正压(PEEP)呈不同程度的上升,PIP上升26例,ALI患儿与呼吸功能正常儿为(28.62±6.38)cmH2O比(20.90±3.60)cmH2O,P<0.05;PEEP为(5.0±1.6)cmH2O比(2.0±0.6)cmH2O,P<0.01。(3)ALI患儿血清TNF-α较正常对照组升高,分别为(32.60±8.62)pg/mL和(8.54±3.04)pg/mL,P<0.001。结论:(1)ALI的肺病理生理变化特点除氧合功能下降或肺泡有效通气减少外,还有小气道阻力升高;(2)全身炎症反应可能参与小儿ALI。Objective： To investigate the pathophysiology and pathogeneses of pediatrics acute lung injury （ALI）. Methods： To compare the differences of the pulmonary function and inflammatory factor between pediatric patients with ALI and cases with normal pulmonary function. Results： （1）The blood gases analysis in pediatric patients with ALI revealed deteriorative oxygenation and ventilation in different levels, There were 47 cases with decreased PaO/FiO2, while there were 27 with increased PaCO2. （2）There were 26 cases with increased peak inspiratory pressure during mechanical ventilation, which valve compared with control group was （28.62±6.38）cmH2O vs. （20.90±3.60）cmH2O, P 〈 0.05, while the positive expiratory ending pressure compared with control group was （5.0±1.6）cmH2O vs. （2.0±0.6） cmH2O,P 〈 0.01. （3）There was an increased serum concentration of TNF-α compared to normal children, which was （32.60±8.62）μg/mL vs, （8.54±3.04）μg/mL,P〈0,001, Conclusions： （1）The pulmonary pathophysiology of ALI indicates either increased resistance of small airway, or decreased oxygenation and effective alveolar ventilation, （2）The systemic inflammatory response may induce pediatrics ALI.

关 键 词：儿科 急性肺损伤 呼吸功能 炎症 

分 类 号：R720.597[医药卫生—急诊医学]