俯卧位机械通气在儿童重症肺炎治疗中的效果探讨  

Curative effect of mechanical ventilation in the prone positioning on severe pneumonia in children

作　　者：董卓亚[1] 吕勤[1] 叶朝辉[1] 吕海涛[1] 

机构地区：[1]浙江省宁波市妇女儿童医院儿科ICU,315000

出　　处：《中华全科医学》2015年第1期69-71,共3页Chinese Journal of General Practice

基　　金：浙江省药学会医院药学科研基金项目(2012ZYY12)

摘　　要：目的观察儿童重症肺炎机械通气治疗时俯卧位的临床疗效。方法选取2010年5月—2013年7月在宁波市妇女儿童医院儿科ICU住院治疗的65例儿童重症肺炎患儿,随机分为试验组和对照组,2组都采用保护性通气模式（小潮气量6~8 ml/kg＋呼气末正压通气）辅助通气,试验组33例在早期机械通气时行俯卧位机械通气（至少有维持10 h/d）;对照组32例行常规仰卧位机械通气,分别观察治疗后6 h、12 h、18 h、24 h动脉血气分析、氧合参数及呼吸机参数的变化,隔天查胸片对照观察肺部炎症变化情况。结果与对照组相比,试验组Pa O2和Pa O2/Fi O2变化差异有统计学意义,1周后胸片肺部炎症吸收明显改善（P〈0.05）。经过2周治疗后,试验组的有效率为78.79%,而对照组为53.13%。结论儿童重症肺炎机械通气治疗中俯卧位机械通气可提高通气效果、更有利于气道分泌物引流,更好地增加氧供,减少对患者的呼吸和血流动力学的影响,从而实现早日撤机,且实施方便,加强护理和观察可避免严重并发症的发生。Objective To observe the clinical effect of mechanical ventilation in the prone positioning on the severe pneu- monia in children. Methods Total 65 children with severe pneumonia admitted to PICU in our hospital from May 2010 to July 2013 were randomly divided into experimental group and control group. All cases in both groups received low tidal volume 6 -8 ml/kg ＋ positive end expiratory pressure lung protective ventilation. The experimental group（33 cases） re- ceived ventilation in the prone positioning at early stage（ at least maintaining 10 hours a day） ,while the control group（ 32 cases ） was given conventional mechanical ventilation in the supine positioning. The changes of arterial blood gas analysis, oxygenation parameters and parameters of mechanical ventilatory at 6 h, 12 h, 18 h and 24 h after the treatment were re- corded. The changes of lung inflammation in the two groups were contrasted by the chest X-ray every other day. Results Compared to control group, the changes of Pa（~ and PaO2/FiO2 in the experimental group showed obvious difference, and the absorption of lung inflammation was significantly improved after one week （ P 〈 0.05 ）. After two weeks of treatment, the effective rate in experimental group was 78.79% ,while the control group was 53.13%. Conclusion The mechanical ventilation in the prone positioning can improve the ventilation effect and promote the drainage of airway secretions, in- crease oxygen supply,reduce the impact on hemodynamics and pneumodynamics in patients with severe pneumonia,which will promote the withdrawal of ventilator. This method is easy to implement in clinic. The intensive care and observation can avoid serious complications.

关 键 词：俯卧位机械通气 儿童 重症肺炎 

分 类 号：R725.6[医药卫生—儿科] R459.6[医药卫生—临床医学]