小潮气量机械通气治疗对小儿重症肺炎血气学指标的影响  

Effect of mechanical ventilation with low tidal volume on blood gas indexes in treatment of children with severe pneumonia

作　　者：杨琳东 王秀萍[1] 王娟[1] YANG Lin-dong WANG Xiu-ping WANG Juan.(Department of Pediatrics, Yan ＇an People ＇s Hospital, Yan＇an 716000, Shaanxi, CHINA)

机构地区：[1]延安市人民医院儿科,陕西延安716000

出　　处：《海南医学》2017年第16期2639-2641,共3页Hainan Medical Journal

基　　金：陕西省延安市科学技术研究发展计划项目(编号:2012kw-04)

摘　　要：目的探讨小潮气量机械通气治疗对小儿重症肺炎血气学指标变化的影响。方法回顾性研究2010年2月至2016年12月在本院应用呼吸机辅助通气治疗的小儿重症肺炎患儿76例,根据潮气量的不同分为小潮气量组42例和常规潮气量组34例,潮气量分别为6~8 m L/kg和10~12 m L/kg。检测上机前和上机6 h、12 h、24 h后两组患儿血气指标变化情况。结果机械通气治疗后,在不同时间点检测,两组患儿动脉血氧分压(PaO_2)、pH值、氧合指数(P/F)均有升高,小潮气量组较明显,差异具有统计学意义(P<0.05);两组患儿的动脉血二氧化碳分压(PaCO_2)均下降,但小潮气量组较为显著,两组PaCO_2数据间的差异具有统计学意义(P<0.05);小潮气量组平均通气时间为(5.31±2.52)d,常规潮气量组平均通气时间为(7.14±1.90)d,小潮气量组通气时间低于常规潮气量组,差异具有统计学意义(P<0.05);小潮气量组死亡1例,死亡原因为呼吸衰竭,常规潮气量组死亡4例,同样死于呼吸衰竭,两组死亡率比较(2.63%vs 10.52%)差异具有统计学意义(P<0.05)。结论小潮气量机械通气可显著提高小儿重症肺炎患儿PaO_2、pH值、P/F,降低PaCO_2,缩短上机时间,减少肺损伤。Objective To investigate the effect of mechanical ventilation with low tidal volume on the changes of blood gas indexes in children with severe pneumonia. Methods A total of 76 children with severe pneumonia who underwent ventilator assisted ventilation treatment in our hospital from February 2010 to December 2016 were retrospective studied. They were divided into the low tidal volume group（n=42） and the conventional tidal volume group（n=34）,and tidal volume were 6-8 m L/kg and 10-12 m L/kg, respectively. The changes of blood gas indexes of two groups before and 6 h, 12 h and 24 h after mechanical ventilation were detected. Results Arterial oxygen tension（Pa O2）, p H value and oxygenation index（P/F） were increased in the two groups after the treatment of mechanical ventilation at different time points. The increase in low tidal volume group was more significant than that in conventional tidal volume group, with statistically significant difference（P〈0.05）. The partial pressure of carbon dioxide（Pa CO2） were decreased in both the two groups, but decrease in the low tidal volume group was more significant（P〈0.05）. The average ventilation time was（5.31±2.52） days in the low tidal volume group, which was significantly shorter than（7.14±1.90） days in the conventional tidal volume group（P〈0.05）. The death rate in low tidal volume group was significantly lower than that in conventional tidal volume group（2.63% vs 10.52%, P〈0.05）, with 1 case in low tidal volume group and 4 cases in conventional tidal volume group, all died of respiratory failure. Conclusion Mechanical ventilation with low tidal volume can significantly improve Pa O2, p H value, P/F in children with severe pneumonia, reduce Pa CO2, shorten mechanical ventilation time and reduce lung injury.

关 键 词：小潮气量 机械通气 肺炎 血气分析 

分 类 号：R725.6[医药卫生—儿科]