腹内压与重症肺炎机械通气患儿呼吸功能的关系及预后预测价值研究  

Study on the relationship between intra-abdominal pressure and respiratory function in children with severe pneumonia undergoing mechanical ventilation and its prognostic value

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作  者:刘灵芝[1] 张群群 王琪[1] 崔利丹 陈晨[1] 金志鹏[1] Liu Lingzhi;Zhang Qunqun;Wang Qi;Cui Lidan;Chen Chen;Jin Zhipeng(Medical Intensive Care Unit,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450000,China)

机构地区:[1]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院内科监护室,郑州450000

出  处:《中华实用儿科临床杂志》2024年第12期931-935,共5页Chinese Journal of Applied Clinical Pediatrics

摘  要:目的探讨腹内压(IAP)与重症肺炎机械通气患儿呼吸功能的关系及预后预测价值。方法病例系列研究。以2019年5月至2021年5月在郑州大学附属儿童医院重症监护室行机械通气治疗的92例重症肺炎患儿为研究对象,监测患儿IAP和呼吸功能相关指标,IAP≥12 mmHg(1 mmHg=0.133 kPa)者为研究组,IAP<12 mmHg者为对照组。比较2组呼吸功能相关指标差异,采用Pearson相关性分析IAP与呼吸功能指标的关系。根据患儿预后将其分为预后良好组和预后不良组,收集2组患儿临床资料进行单因素分析,采用多因素Logistic回归分析影响重症肺炎机械通气患儿预后的危险因素,绘制受试者工作特征(ROC)曲线分析IAP对重症肺炎机械通气患儿预后的预测价值。结果研究组动脉氧分压(PaO_(2))[(80.15±8.23)mmHg比(85.74±8.42)mmHg]、动脉血氧饱和度(SaO_(2))[(91.32±2.13)%比(97.05±2.47)%]、氧合指数(PaO_(2)/FiO_(2))[(198.29±20.25)mmHg比(234.84±25.24)mmHg]均低于对照组,呼吸频率(RR)[(56.23±2.16)次/min比(50.41±2.24)次/min]、二氧化碳分压(PaCO_(2))[(36.48±3.72)mmHg比(33.29±3.46)mmHg]、吸入氧浓度(FiO_(2))[(40.42±4.25)%比(36.51±3.72)%]、平均动脉压(MAP)[(55.98±5.69)mmHg比(52.79±5.43)mmHg]、呼气末正压(PEEP)[(5.03±0.52)cmH_(2)O比(4.52±0.47)cmH_(2)O,1 cmH_(2)O=0.098 kPa]均高于对照组,差异均有统计学意义(均P<0.05)。研究组患儿IAP为(14.25±1.83)mmHg,对照组为(10.38±1.14)mmHg,Pearson相关性分析显示,IAP与PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)均呈负相关(r=-0.615、-0.587、-0.647,均P<0.05);IAP与RR、PaCO_(2)、FiO_(2)、MAP、PEEP均呈正相关(r=0.618、0.634、0.579、0.578、0.593,均P<0.05)。预后不良组患儿IAP[(14.76±1.58)mmHg比(10.75±1.19)mmHg]、PaCO_(2)[(39.95±4.21)mmHg比(35.37±3.64)mmHg]、FiO_(2)[(50.29±5.12)%比(45.38±4.47)%]、丙氨酸转氨酶[(42.08±4.15)U/L比(39.87±4.06)U/L]、总胆红素[(17.92±1.87)μmol/L比(17.09±1.75)μmol/L]均高于预后良好组ObjectiveTo investigate the relationship between intra-abdominal pressure(IAP)and respiratory function in mechanically ventilated children with severe pneumonia and its prognostic value.MethodsA case-series study.Ninety-two children with severe pneumonia who were treated with mechanical ventilation in the Intensive Care Unit of Children′s Hospital Affiliated to Zhengzhou University from May 2019 to May 2021 were taken as the study subjects.The IAP and respiratory function-related indexes of the children were monitored.Those with IAP≥12 mmHg(1 mmHg=0.133 kPa)were divided into the study group,and those with IAP<12 mmHg were divided into the control group.The difference in respiratory function related indexes between the 2 groups was compared,and the relationship between IAP and respiratory function indexes was analyzed by Pearson correlation.The children were divided into a good prognosis group and a poor prognosis group according to their prognosis.The relevant clinical data of the children in the 2 groups were collected for univariate analysis,and multivariate Logistic regression was used to analyze the risk factors affecting the prognosis of children with mechanical ventilation for severe pneumonia.A receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of IAP on the prognosis of mechanically ventilated children with severe pneumonia.ResultsThe arterial partial pressure of oxygen(PaO_(2))[(80.15±8.23)mmHg],arterial blood oxygen saturation(SaO_(2))[(91.32±2.13)%],and oxygenation index(PaO_(2)/FiO_(2))[(198.29±20.25)mmHg]in the study group were lower than those in the control group[(85.74±8.42)mmHg,(97.05±2.47)%,and(234.84±25.24)mmHg],while the respiratory rate(RR)[(56.23±2.16)breaths/min vs.(50.41±2.24)breaths/min],partial pressure of carbon dioxide(PaCO_(2))[(36.48±3.72)mmHg vs.(33.29±3.46)mmHg],fraction of inspired oxygen(FiO_(2))[(40.42±4.25)%vs.(36.51±3.72)%],mean arterial pressure(MAP)[(55.98±5.69)mmHg vs.(52.79±5.43)mmHg],and positive end expiratory pressure

关 键 词:重症肺炎 机械通气 腹内压 呼吸功能 预后 

分 类 号:R725.6[医药卫生—儿科]

 

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