俯卧位通气在儿童急性呼吸窘迫综合征的应用及注意事项  

Application and precautions of prone position ventilation in pediatric acute respiratory distress syndrome

作　　者：符跃强[1] 许峰[1] Fu Yueqiang;Xu Feng(Department of Critical Care Medicine,Children′s Hospital,Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆400014

出　　处：《中国小儿急救医学》2022年第7期481-485,共5页Chinese Pediatric Emergency Medicine

基　　金：重庆医科大学未来医学青年创新团队发展支持计划:儿童危重症基础与临床(2021-W0111)。

摘　　要：俯卧位通气是治疗中重度儿童急性呼吸窘迫综合征(PARDS)的有效手段,应该在早期使用,能提高机体氧合并降低病死率。但是,目前俯卧位通气在中重度PARDS中的使用率仍然不高,可能与临床医师对其治疗作用认识不到位和缺乏训练有术的员工有关。俯卧操作需要医生和护士的协调努力,常规需要3~5位医务人员参与,必须仔细固定气管插管和各种有创管路,操作过程中注意患儿安全,避免有创管路的脱落、移位或扭结。体外膜肺氧合治疗的患儿可以进行俯卧位通气,但需要增加操作人员管理体外膜肺的管路。专业医务人员应接受俯卧操作相关培训,掌握其使用的禁忌证,注意避免相关并发症。新冠肺炎疫情发生后,俯卧位通气的应用逐渐增多。俯卧位通气治疗急性呼吸窘迫综合征的关键研究进展多来自于成人领域。希望未来对俯卧位通气在中重度PARDS的使用开展更多的临床研究,以便更好地救治PARDS患儿。Prone position ventilation(PPV)is an effective treatment for moderate to severe pediatric acute respiratory distress syndrome(PARDS)and should be used in the early stage.PPV can improve oxygenation and reduce mortality.However,at present,the rate of application of PPV in moderate to severe PARDS is still low,which may be related to the insufficient understanding of its therapeutic effect and the lack of trained and skilled staff.Prone operation requires the coordinated efforts of doctors and nurses.Three to five medical personnel are required to participate in this routine operation,and the endotracheal tube and various invasive tubes must be carefully fixed.The safety of children during the prone operation should be guaranteed,and the extubation,migration or kinking of invasive pipelines must be avoided.Children receiving extracorporeal membrane oxygenation can be ventilated in prone position,but additional operators are required during prone operation.Medical staff should receive training related to the prone operation,master the contraindications of PPV,and avoid related complications.After the outbreak of COVID-19,the application of PPV has gradually increased.The key research progress of PPV in acute respiratory distress syndrome mostly comes from the adult field.More clinical studies should be carried out on the use of PPV in pediatrics in the future,so as to better treat PARDS.

关 键 词：俯卧位通气 儿童急性呼吸窘迫综合征 病死率 禁忌证 并发症 

分 类 号：R725.6[医药卫生—儿科]