重症肺炎患儿仰、俯卧位通气联合高频胸壁振荡排痰及超短波理疗的效果比较  

Comparison of the efficacy of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration and ultrashort wave physiotherapy in children with severe pneumonia

作　　者：刘培培 李晓曦 李艳平 曹田田 王茜 LIU Peipei;LI Xiaoxi;LI Yanping;CAO Tiantian;WAN Xi(Department of Pediatrics,The First Affiliated Hospital of Bengbu Medical University,Bengbu Anhui 233004;School of Pharmacy,Bengbu Medical University,Bengbu Anhui 233030,China;School of Nursing,Bengbu Medical University,Bengbu Anhui 233030,China)

机构地区：[1]蚌埠医科大学第一附属医院儿科,安徽蚌埠233004 [2]蚌埠医科大学药学院,安徽蚌埠233030 [3]蚌埠医科大学护理学院,安徽蚌埠233030

出　　处：《蚌埠医学院学报》2024年第5期663-668,673,共7页Journal of Bengbu Medical College

基　　金：蚌埠医学院自然科学研究重点项目(BYKY2019207skZD)。

摘　　要：目的:探讨仰、俯卧位通气联合高频胸壁振荡排痰及肺部超短波理疗(SW)对重症肺炎患儿氧合指标、痰液特点、血清细胞因子及临床症状改善的影响。方法:选取行机械通气的重症肺炎患儿60例,随机分为仰卧位通气组(SP组)、SP+SW组、俯卧位通气组(PP组)、PP+SW组,各15例。分别观察各组不同时点肺泡-动脉氧分压差、血氧分压、二氧化碳分压、脉搏血氧饱和度、氧合指数、气道内痰液黏稠度和痰液量及血清肿瘤坏死因子α、白细胞介素(IL)-2、IL-6、IL-10水平,以及各组发热时间、啰音消失时间、机械通气时间情况。结果:PP组、PP+SW组各时点动脉血氧分压、脉搏血氧饱和度、氧合指数均明显高于SP组和SP+SW组(P<0.01),肺泡-动脉氧分压差、二氧化碳分压均明显低于SP组和SP+SW组(P<0.01)。机械通气48、72 h,PP+SW组痰液排出量均明显低于其他3组(P<0.01)。PP+SW组24、48、72 h时肿瘤坏死因子α、IL-2、IL-6、IL-10水平均明显低于其他3组(P<0.01)。PP+SW组退热、肺部啰音消失、X线片病灶吸收和机械通气时长均明显低于其他3组(P<0.01)。结论:俯卧位通气下联合高频胸壁振荡排痰及SW能改善重症肺炎患儿氧合指标,降低气道痰液黏稠度并利于排痰,控制机体炎症免疫反应,促进临床症状恢复。Objective:To investigate the effects of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration(HFCWO)and lung ultrashort wave physiotherapy(SW)on the improvement of oxygenation indexes,sputum characteristics,serum cytokines and clinical symptoms in children with severe pneumonia.Methods:Sixty children with severe pneumonia treated with mechanically ventilation were randomly divided into the supine position ventilation(SP)group,SP+SW group,prone position ventilation(PP)group and PP+SW group(15 cases each group).The alveolar arterial oxygen differential pressure,blood oxygen partial pressure,carbon dioxide partial pressure,pulse blood oxygen saturation,oxygenation index,sputum viscosity and sputum volume in airway,serum levels of tumor necrosis factorα,interleukin(IL)-2,IL-6,IL-10,fever time,rale disappearance time and mechanical ventilation time in each group were observed at different time points.Results:The arterial oxygen partial pressure,pulse oxygen saturation and oxygenation index in the PP and PP+SW groups were significantly higher than those in SP and SP+SW groups at all time points(P<0.01),and the alveolar artery oxygen partial pressure and carbon dioxide partial pressure in the PP and PP+SW groups were significantly lower than those in SP and SP+SW groups(P<0.01).After 48 and 72 h of mechanical ventilation,the sputum output in PP+SW group was significantly lower than that in other 3 groups(P<0.01).The levels of tumor necrosis factorα,IL-2,IL-6 and IL-10 in the PP+SW group at 24,48 and 72 h were significantly lower than those in other 3 groups(P<0.01).The duration of fever,lung rales,lesion absorption and mechanical ventilation in the PP+SW group were significantly lower than those in other 3 groups(P<0.01).Conclusions:Prone position ventilation combined with high-frequency chest wall oscillation expectoration and SW can improve the oxygenation index,reduce the viscosity of airway sputum,facilitate expectoration,control the body′s inflammatory and immun

关 键 词：重症肺炎 俯卧位通气 高频胸壁振荡排痰 超短波理疗 

分 类 号：R725.6[医药卫生—儿科] R473[医药卫生—临床医学]