鱼油脂肪乳联合肠外营养支持对先天性心脏病术后机械通气患儿血气指标及呼吸力学的影响  

Effects of fish oil fat emulsion combined with parenteral nutrition support on blood gas parameters and respiratory mechanics in children with congenital heart disease after mechanical ventilation post-surgery

作　　者：沈美丽 陈志旭[1] 陈伟虹 许成娜 林益虎 位永娟[2] Shen Meili;Chen Zhixu;Chen Weihong;Xu Chengna;Lin Yihu;Wei Yongjuan(Intensive Care Department,Quanzhou Children’s Hospital,Quanzhou 362000,China;Pediatric Surgery Department of Quanzhou Children’s Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市儿童医院重症医学科,泉州362000 [2]泉州市儿童医院小儿外科,泉州362000

出　　处：《临床小儿外科杂志》2024年第7期627-632,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨鱼油脂肪乳联合肠外营养支持对先天性心脏病术后机械通气患儿血气指标及呼吸力学的影响。方法回顾性分析2020年1月至2023年10月泉州市儿童医院重症医学科先天性心脏病外科手术后行机械通气治疗的50例患儿临床资料,采用随机双盲法将其分为研究组和对照组,两组均为25例。对照组于进入重症监护室(intensive care unit,ICU)48 h后行肠外营养支持,研究组于进入ICU 48 h后行肠外营养支持,并在肠外营养基础上加用鱼油脂肪乳;两组均在干预7 d后进行效果评价,包括营养指标、炎症因子、血气指标、呼吸力学指标。结果干预后,研究组与对照组血清白蛋白(albumin,ALB)[(41.43±4.26)g/L比(36.85±3.82)g/L]、前白蛋白(prealbumin,PA)[(182.32±21.24)mg/L比(153.37±18.65)mg/L]、转铁蛋白(transferrin,TRF)[(2.62±0.57)g/L比(2.18±0.48)g/L]均较干预前升高,差异有统计学意义(P<0.05)。干预后,研究组与对照组动脉血氧分压(partial pressure of oxygen,PaO_(2))[(81.33±6.26)mmHg比(72.85±8.15)mmHg]、氧合指数[(258.87±35.12)比(223.54±31.65)]、弥散指数[(244.37±36.32)比(213.64±28.85)]较干预前升高,动脉二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO_(2))[(43.46±4.25)mmHg比(48.87±5.32)mmHg]、Lac[(1.35±0.22)mmol/L比(92.12±0.27)mmol/L]较干预前降低,其中研究组PaO_(2)、氧合指数、弥散指数高于对照组,PaCO_(2)、Lac低于对照组,差异有统计学意义(P<0.05)。干预后,研究组与对照组血清白细胞介素(interleukin,IL)-1β[(11.26±3.53)pg/mL比(16.65±3.85)pg/mL]、IL-6[(52.54±8.45)pg/mL比(73.32±9.37)pg/mL]、肿瘤坏死因子(tumor necrosis factor,TNF)-α[(6.35±1.14)μg/L比(9.32±1.85)μg/L]较干预前降低,且研究组低于对照组,差异有统计学意义(P<0.05)。干预后,研究组与对照组气道阻力(inhalation resistance,Raw)[(8.26±2.35)cmH_(2)O/L·s比(11.24±2.87)cmH_(2)O/L·s]较干预前降低,肺顺应性(lung complianObjective To explore the effects of fish oil fat emulsion combined with parenteral nutrition support on blood gas parameters and respiratory mechanics in children with congenital heart disease after mechanical ventilation post-surgery.Methods A retrospective analysis was conducted on the clinical data of 50 children with congenital heart disease who underwent mechanical ventilation in the Intensive Care Department of Quanzhou Children’s Hospital from January 2020 to October 2023.The patients were randomly divided into a study group and a control group using a double-blind method,with 25 cases in each group.The control group received parenteral nutrition support 48 hours after intensive care unit(ICU)admission.The study group received parenteral nutrition support combined with fish oil fat emulsion 48 hours after ICU admission.The intervention effects,including nutritional indicators,inflammatory factors,blood gas parameters,and respiratory mechanics,were evaluated after 7 days.Results After the intervention,the study group showed significant increases in serum albumin(ALB),prealbumin(PA),and transferrin(TRF)compared to before the intervention(P<0.05),with statistically significant differences(P<0.05).Blood gas parameters showed that the partial pressure of oxygen(PaO_(2)),oxygenation index,and diffusion index increased in the study group compared to before the intervention,while the partial pressure of carbon dioxide in arterial blood(PaCO_(2))and lactate(Lac)decreased.The study group had higher PaO_(2),oxygenation index,and diffusion index,and lower PaCO_(2)and Lac compared to the control group,with statistically significant differences(P<0.05).In terms of cytokines,interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-αdecreased in the study group compared to before the intervention,and were lower than the control group(P<0.05),with statistically significant differences(P<0.05).Respiratory mechanics showed that inhalation resistance(Raw)decreased and lung compliance(CL)increased in the study group compared

关 键 词：机械通气 鱼油脂肪乳 肠外营养 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]