CT定位下纤维支气管镜气道灌洗联合B超监测膈肌运动在小儿重症肺炎机械通气中的应用效果  

Applied effects of airway lavage of fiberoptic bronchoscope under CT location combined with ultrasound monitoring diaphragmatic movement in mechanical ventilation of pediatric severe pneumonia

作　　者：谭丽 朱晓萍 赵敏[4] 胡绍举 Tan Li;Zhu Xiaoping;Zhao Min;Hu Shaoju(Academy of Pediatrics,Guizhou Medical University,Guiyang 550004,China;Department of Pediatrics,The People's Hospital of Liupanshui City,Liupanshui 553001,China;Department of Pediatrics,Children's Medical Center Affiliated to Guizhou Medical University,Guiyang 550004,China;Department of Pediatric Critical Care Medicine,Liupanshui Maternal and Child Health Care Hospital,Liupanshui 553001,China)

机构地区：[1]贵州医科大学儿科学院,贵阳550004 [2]六盘水市人民医院儿科,六盘水553001 [3]贵州医科大学附属儿童医学中心儿科,贵阳550004 [4]六盘水市妇幼保健院儿童重症医学科,六盘水553001

出　　处：《中国医学装备》2024年第10期62-68,共7页China Medical Equipment

基　　金：贵州省卫生健康科技计划(2022RC174)。

摘　　要：目的:探讨CT定位下纤维支气管镜气道灌洗联合B超监测膈肌运动在小儿重症肺炎机械通气中的应用效果。方法:选取2022年10月至2023年10月于六盘水市人民医院及妇幼保健院收治的70例小儿重症肺炎机械通气患儿,根据随机数表法将其分为对照组和观察组,每组35例。对照组在支气管镜灌洗前未做肺部CT检查进行传统灌洗,观察组在气道灌洗前均给予CT检查,同时采用B超监测膈肌运动。检测患儿灌洗前后的心率、呼吸、血氧饱和度、呼吸力学指标以及评估儿童早期预警评分(PEWS)和改良的肺炎幸存者指数(mPIRO)评分,并通过B超测量患儿的膈肌移动度、厚度。结果:两组灌洗治疗后心率、呼吸频次均明显低于治疗前,血氧饱和度明显高于治疗前,且观察组治疗后心率(80.23±10.07)次/min、呼吸频次(18.11±5.03)次/min均明显低于对照组,血氧饱和度(97.22±1.08)%明显高于对照组,差异有统计学意义(t=3.397、3.939、7.719,P<0.05);两组灌洗治疗后肺内压、峰压、平台压、平均气道压、胸压、腹压均明显低于治疗前,且观察组上述指标水平均明显低于对照组,差异有统计学意义(t=12.323、8.141、16.733、12.298、11.375、18.248,P<0.05);两组治疗后体温、脉搏、呼吸、血压各项PEWS评分及总分均明显低于治疗前,且观察组上述评分均明显低于对照组,差异有统计学意义(t=67.309、58.148、35.997、30.218、5.271,P<0.05);两组灌洗治疗后年龄、实验室检测指标、症状持续时间、呼吸窘迫指数、治疗方案各项mPIRO评分及总分均明显高于治疗前,且观察组上述评分均明显高于对照组,差异有统计学意义(t=7.432、7.153、7.268、5.088、4.645、4.091,P<0.05);两组治疗后膈肌移动度、厚度均明显高于治疗前,且观察组上述指标均明显高于对照组,差异有统计学意义(t=63.444、6.803,P<0.05)。结论:与传统的气道灌洗相比,CT定位下纤维支气管镜气Objective:To investigate the applied effect of airway lavage of fiberoptic bronchoscope under computed tomography(CT)location combined with ultrasound monitoring diaphragmatic movement in mechanical ventilation of pediatric severe pneumonia.Methods:A total of 70 pediatric patients with severe pneumonia who received mechanical ventilation in The People's Hospital of Liupanshui City and Liupanshui Maternal and Child Health Care Hospital from October 2022 to October 2023 were selected,and they were divided into a control group and an observation group according to the random number table method,with 35 cases in each group.The control group did not undergo CT examination for lung before lavage with bronchoscopy,while the observation group received CT examination before airway lavage.Both two groups simultaneously adopted B ultrasound to monitor diaphragm movement.Heart rate,respiration,oxygen saturation,respiratory mechanics index,pediatric early warning score(PEWS)and modified pneumonia survivor index(mPIRO)score were detected before and after lavage,and the movement and thickness of diaphragm of children were measured by B ultrasound.Results:The heart rate and respiratory frequency of two groups after treatment were significantly lower than those before treatment,and the blood oxygen saturation was significantly higher than that before treatment.The heart rate and respiratory frequency of the observation group were respectively(80.23±10.07)times/min and(18.11±5.03)times/min,which were significantly lower than those of the control group,and the blood oxygen saturation was significantly higher than that of the control group,and the differences were statistical significance(t=3.397,3.939,7.719,P<0.05),respectively.The pulmonary pressure,peak pressure,plateau pressure,average airway pressure,chest pressure and abdominal pressure of two groups after treatment were significantly lower than those before treatment,and the levels of the above indicators in the observation group were significantly lower than those in the c

关 键 词：CT定位 纤维支气管镜气道灌洗 B超监测 膈肌运动 小儿重症肺炎 机械通气 

分 类 号：R816.4[医药卫生—放射医学]