胃黏膜pH值评估重症婴幼儿肺炎胃黏膜损伤的价值  

Gastric intramucosal pH values in assessment of gastric mucosal lesions in infants and toddlers with severe pneumonia

作　　者：王海磊[1] 马娜 

机构地区：[1]河南大学淮河医院PICU,河南开封475000 [2]河南省开封市儿童医院神经内科,河南开封475000

出　　处：《临床儿科杂志》2015年第11期955-957,共3页Journal of Clinical Pediatrics

摘　　要：目的探讨胃黏膜pH值评估辅助呼吸重症婴幼儿肺炎患儿胃黏膜损伤的应用价值。方法选择120例诊断为重症肺炎的婴幼儿为研究对象,所有患儿根据病情均给予压力支持-同步间歇指令通气(PSV-SIMV)模式辅助呼吸,于辅助呼吸前15 min及辅助呼吸后1、6、12、24 h行血气分析并测定计算胃黏膜p H值,通过分析胃黏膜pH值与动脉血气分析氧分压(PaO2)水平等的相关性评价其应用价值。结果随着通气治疗时间延长,胃黏膜pH值、PaO2、PaO2/吸入氧浓度(FiO2)呈上升趋势,胃黏膜二氧化碳分压(PgCO2)-PaCO2及血乳酸呈下降趋势,差异有统计学意义(P<0.05);通气后18 h Pg CO2-Pa CO2、Pa O2、PaO2/FiO2及血乳酸开始恢复正常,通气后24 h接近正常,而胃黏膜p H值通气后24 h仍明显低于正常,36h后恢复正常。胃黏膜pH值与PgCO2-Pa CO2及血乳酸负相关(r=-0.30、-0.23,P均<0.05),与PaO2及PaO2/FiO2正相关(r=0.26,0.16,P均<0.05)。结论胃黏膜pH值可以较准确、敏感地反映重症肺炎需要辅助呼吸婴幼儿胃黏膜损伤情况。Objectives To evaluate the application of gastric intramucosal p H values in assessment of the gastric mucosal lesions in infants and toddlers with severe pneumonia. Methods One hundred and twenty（120） infants and toddlers with severe pneumonia were recruited. All subjects were treated with pressure support- synchronized intermittent mandatory ventilation according to the condition. The blood gas analysis and gastric carbon dioxide partial pressure（Pg CO2） detection were performed at 15 minutes before ventilation and l h,6 h,12 h,18 h,24 h after ventilation,and the gastric intramucosal p H were calculated. Results With prolonged ventilation,the gastric intramucosal p H,Pa O2 and Pa O2/fraction of inspired oxygen（Fi O2） were significantly increased,while the（Pg CO2-Pa CO2） and blood lactic acid were significantly decreased. The（Pg CO2-Pa CO2）,Pa O2,Pa O2/Fi O2,and blood lactic acid began to return normal at 18 h after ventilation,and close to normal at 24 h after ventilation. The gastric intramucosal p H was still significantly lower than normal at 24 h after ventilation,and return to normal at 36 h after ventilation. There were negative correlations between gastric intramucosal p H with（Pg CO2-Pa CO2） and blood lactic acid（r=-0.30,-0.23,P〈0.05）,and positive correlations between gastric intramucosal p H with Pa O2 and Pa O2/Fi O2（r=0.26,0.16,P〈0.05）. Conclusion Gastric intramucosal p H can be served as a sensitive and accurate indicator for gastric mucosal lesions of severe pneumonia in infants and toddlers who need mechanical ventilation.

关 键 词：胃黏膜PH值 重症肺炎 婴幼儿 

分 类 号：R725.6[医药卫生—儿科]