经超声评估并结合HFNCO技术对有创机械通气患儿疗效评价的研究  

Study on the efficacy evaluation of invasive mechanical ventilation in children using ultrasound evaluation combined with HFNCO technology

作　　者：石瑶 李远兴 陈智辉 李淑明 SHI Yao;LI Yuanxing;CHEN Zhihui;LI Shuming(Department of Ultrasound,Dalang Hospital of Dongguan,Dongguan 523770,China)

机构地区：[1]东莞市大朗医院超声科,广东东莞523770

出　　处：《医用气体工程》2025年第1期33-36,共4页Medical Gases Engineering

摘　　要：目的:探讨重症加强护理病房(intensive care unit,ICU)中有创机械通气>48 h患儿经超声评估并结合加温加湿经鼻高流量氧疗(high-flow nasal cannula oxygenation,HFNCO)对拔管成功率的影响。方法:选择2022年11月至2023年11月我院ICU接受有创机械通气治疗超过48 h患儿60例作为研究对象,根据拔管后治疗方法分为对照组和观察组,各30例,所有患儿均实施肺部超声评估,其中对照组在拔管之后给予无创通气氧疗,观察组则在拔管止呕后给予HFNCO治疗,比较不同治疗方法的治疗疗效,同时在撤机时根据是否撤机成功进行分组,观察其超声指标情况。结果:观察组拔管后动脉血气指标情况均优于对照组(P<0.05)。观察组拔管后HR以及RR均优于对照组(P<0.05),SPO2比较无明显差异(P>0.05)。观察组拔管临床相关指标均优于对照组(P<0.05)。观察组拔管后48 h内呼吸衰竭发生率与再拔管率均低于对照组(P<0.05)。撤机失败组与撤机成功组在超声观察下自主呼吸试验开始后膈肌位移变化存在明显差异(P<0.05)。结论:对于ICU内有创机械通气治疗时间在48 h以上患儿,经过超声评估,可有效评估患儿膈肌情况,以确定撤机时机。Objective:To explore the effect of ultrasound evaluation combined with high-flow nasal cannula oxygenation(HFNCO)with heating and humidification on the success rate of extubation in children with invasive mechanical ventilation for more than 48 h in intensive care unit(ICU).Methods:Sixty children who received invasive mechanical ventilation treatment for more than 48 h in ICU of our hospital from November 2022 to November 2023 were selected as the research subjects.According to the treatment methods after extubation,they were divided into control group and observation group,with 30 cases in each group.All children underwent pulmonary ultrasound evaluation.The control group received non-invasive ventilation oxygen therapy after extubation,while the observation group received HFNCO treatment after extubation and antiemetic treatment.The therapeutic effects of different treatment methods were compared.At the same time,the children were divided into two groups based on whether extubation was successful,and their ultrasound indicators were observed.Results:The arterial blood gas indicators in the observation group were better than those in the control group after extubation(P<0.05).The HR and RR of the observation group after extubation were better than those of the control group(P<0.05),while there was no significant difference in SPO2(P>0.05).The clinical indicators related to extubation in the observation group were superior to those in the control group(P<0.05).The incidence of respiratory failure and the rate of re-extubation within 48 h after extubation in the observation group were lower than those in the control group(P<0.05).There was a significant difference in the changes of diaphragm displacement between the failed and successful weaning groups after the start of the spontaneous breathing test under ultrasound observation(P<0.05).Conclusion:For children undergoing invasive mechanical ventilation treatment in ICU for more than 48 h,ultrasound evaluation can effectively assess the condition of children’s d

关 键 词：有创机械通气 超声 加温加湿经鼻高流量氧疗 拔管 

分 类 号：R473[医药卫生—护理学]