不同潮气量通气策略对小儿急性肺损伤/急性呼吸窘迫综合征患者预后的影响

摘要

目的:探讨不同潮气量通气策略对小儿急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患儿预后的影响.方法:根据潮气量不同将我院诊治的ALI/ARDS患儿102例分为2组:传统潮气量组(10~12 mL/kg潮气量)51例,小潮气量组(6~8 mL/kg潮气量)51例.观察并比较2组机械通气后血气分析变化、呼吸机参数变化,记录2组机械通气时间、住PICU时间、住院时间、病死率.结果:通气后24 h,2组PaO2、pH及SaO2较通气即刻升高、PaCO2较通气即刻降低,且小潮气量组PaO2、pH及SaO2高于传统潮气量组、PaCO2低于传统潮气量组.通气0 d、1 d、3 d小潮气量组VT、MAP、PEEP、PIP呼吸机参数较同时间传统潮气量组较低、FiO2比较差异无统计学意义.小潮气量组机械通气时间、住RICU时间、住院时间、病死率均小于传统潮气量组,2组不良反应发生率比较差异无统计学意义.结论:小潮气量通气策略治疗小儿ALI/ARDS预后效果可能优于传统潮气量通气策略,值得进一步探究.%Objective To explore influence on prognosis of different tidal volume ventilation strategies on Children with acute lung injury(ALI)/ acute respiratory distress syndrome(ARDS). Methods According to different tidal volume, one hundred and two cases of children with ALI / ARDS treated in our hospital were divided into two groups: conventional tidal volume group (10~12 mL/kg tidal volume) and small tidal volume group (6 to 8 ml/kg tidal volume), 51 cases in each group. The changes of blood gas analysis and parameters of ventilator were recorded after mechanical ventilation in the two groups. The mechanical ventilation time, PICU time, hospitalization days, and mortality rate were recorded in the two groups. Results PaO2, pH, SaO2 immediately increased after twenty-four hours'ventilation in the two groups, while PaCO2 immediately decreased, and PaO2, pH, SaO2 of small tidal volume group were higher than those of conventional tidal volume group, while PaCO2 was lower than that of conventional tidal volume group. After ventilation of 0 d, 1 d and 3 d, ventilator parameters of VT, MAP, PEEP, PIP of small tidal volume group were lower than those of traditional tidal volume group in the same time, and there was no significant difference in FiO2. The mechanical ventilation time, RICU time, hospitalization days, and mortality rate of small tidal volume group were less than those of traditional tidal volume group. There was no significant difference in incidence of adverse reactions between the two groups. Conclusion The effect of small tidal volume ventilation strategy may be superior to that of traditional tidal volume ventilation strategy on prognosis of children with ALI/ARDS. It is worthy of further exploration.