肺超声指导下的体位管理在新生儿呼吸机相关性肺炎中的临床应用  

Clinical application of positioning management under ultrasound guidance in neonatal ventilator-associated pneumonia

作　　者：黄惜华[1] 麦晓蔚 李惠怡[1] 李琳 孟琼[1] 梁振宇[1] HUANG Xi-hua;MAI Xiao-wei;LI Hui-yi;LI Lin;MENG Qiong;LIANG Zhen-yu(Department of Pediatrics,Guangdong Second Provincial General Hospital,Guangzhou 510220,Guangdong,China;不详)

机构地区：[1]广东省第二人民医院儿科,广东广州510220 [2]广州市番禺区中心医院急诊科,广东广州511400

出　　处：《广东医学》2024年第5期577-582,共6页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金项目(A2022327)。

摘　　要：目的探索肺超声指导下的体位管理在新生儿呼吸机相关性肺炎(VAP)中的临床效果。方法选取新生儿科收治的胎龄>32周且诊断为VAP的患儿50例为研究对象,采用随机数字表法分为肺超声指导下的体位管理组(观察组)和常规体位管理组(对照组)。比较两组患儿肺超声征象、实施方案后血气分析、氧合指数、肺超声评分、呼吸机使用情况、住院时间、并发症等情况。结果两组背部超声评分均较胸前或侧胸评分高,干预7 d后,观察组的胸前、侧胸及背部超声评分均较对照组降低,差异均有统计学意义(P<0.05);其中背部超声评分较胸前及侧胸评分高且变化明显,差异有统计学意义(P<0.05)。观察组在干预3、7 d的总超声评分均较对照组降低,差异有统计学意义(P<0.05);其中观察组干预7 d后的总超声评分较干预前(首次)显著降低(P<0.05)。观察组干预后第7天的氧合指数较干预前明显降低,且较对照组低,差异有统计学意义(P<0.05)。观察组与对照组在呼吸机使用时间差异有统计学意义(P<0.05)。结论肺超声可作为监测手段指导的新生儿VAP的体位管理,有助于缩短新生儿VAP患儿的呼吸机使用时间,值得临床推广应用。Objective To explore the clinical effects of positioning management under ultrasound guidance in neonatal ventilator-associated pneumonia(VAP).Methods Fifty neonates with gestational age>32 weeks diagnosed with VAP and admitted to the Department of Pediatrics were randomly divided into the ultrasound-guided positioning management group(experimental group)and the conventional positioning management group(control group).The lung ultrasound manifestations,blood gas analysis,oxygenation index,lung ultrasound scores,ventilator usage,length of hospital stay,and complications were compared between the two groups.Results The back ultrasound scores in both groups were higher than the front or lateral chest scores.After 7 days of intervention,the front,lateral chest,and back ultrasound scores in the experimental group were significantly lower than those in the control group(P<0.05).Among them,the back ultrasound score was higher than the front and lateral chest scores and showed significant changes(P<0.05).The total ultrasound scores in the experimental group were significantly lower than those in the control group after 3 and 7 days of intervention(P<0.05).The total ultrasound score in the experimental group significantly decreased after 7 days of intervention compared to before the intervention(P<0.05).The oxygenation index on the 7th day after intervention in the experimental group was significantly lower than before the intervention and lower than that in the control group(P<0.05).There were statistically significant differences between the experimental and control groups in ventilator usage time,and time to removal of nasogastric tube(P<0.05).Conclusion Pulmonary ultrasound can serve as a monitoring tool to guide the position management of neonatal VAP,which helps to shorten the time of ventilator use in neonatal VAP patients and is worthy of clinical promotion and application.

关 键 词：肺超声 体位管理 新生儿呼吸机相关性肺炎 新生儿呼吸机辅助通气 

分 类 号：R272.1[医药卫生—中医儿科学] R320.114.0[医药卫生—中医学]