呼气末二氧化碳波形图监测对PICU机械通气患儿应用效果分析

Effect of end-tidal carbon dioxide oscillogram on the monitoring of mechanical ventilation in children patients with PICU

目的临床常采用末梢血氧饱和度对儿科重症监护室(pediatric intensive care unit,PICU)机械通气过程中的生命体征监测,但此种监测方式对儿科重症患儿缺乏一定的直观性。近年来,呼气末二氧化碳波形图在临床上广泛应用。本研究对呼气末二氧化碳波形图监测在PICU机械通气患儿中的应用效果进行评估与分析,为临床监测提供思路和方案支持。方法选取2017-07-01-2018-07-01郑州大学附属儿童医院PICU实施机械通气治疗的106例患儿为研究对象,根据患儿的性别、年龄等因素选择对照组与观察组,每组53例。观察组实施呼气末二氧化碳波形图监测,对照组未实施呼气末二氧化碳波形图监测。分析两组患儿病情的监测情况,对比分析两组不良事件发生、响应情况以及预后。结果观察组机械通气不良事件的发生率为28.3%,与对照组的45.3%比较,差异无统计意义,χ2=3.295,P=0.070。观察组错误插管响应时间为(0.58±0.17)min,短于对照组的(2.11±0.42)min,t=24.583,P<0.001;呼吸机管路脱落响应时间为(0.24±0.12)min,短于对照组的(0.88±0.15)min,t=24.255,P<0.001;呼吸机管路打折或扭曲响应时间为(1.05±0.34)min,短于对照组的(1.87±0.26)min,t=13.947,P<0.001;通气不足响应时间为(4.12±0.78)min,短于对照组的(7.61±1.23)min,t=17.445,P<0.001。观察组治愈出院率为98.11%,高于对照组的94.34%;死亡率为1.89%,低于对照组的5.66%;治愈出院率与死亡率两组比较差异均无统计学意义,χ2值分别为0.139和0.266,P值分别为0.308和0.610。结论呼气末二氧化碳波形图监测在PICU机械通气患儿中的应用效果显著,能及时发现机械通气不良事件,改善患者的预后。

OBJECTIVE In clinic,peripheral blood oxygen saturation is often used to monitor vital signs during mechanical ventilation in pediatric intensive care unit(PICU),but this monitoring method is not intuitive for pediatric severe children.In recent years,end expiratory carbon dioxide waveform has been widely used in clinic.This study evaluated and analyzed the application effect of end expiratory carbon dioxide waveform monitoring in children with mechanical ventilation in PICU,so as to provide ideas and program support for clinical monitoring.METHODS From July 1,2017 to July 1,2018,106 children with mechanical ventilation in the pediatric intensive care unit of our hospital were selected as the study subjects.The control group and the observation group were selected according to sex and age of the children and with 53 cases in each group.The observation group was given the monitoring of the end-tidal carbon dioxide oscillogram,and the control group did not implement the monitoring of the end-tidal carbon dioxide oscillogram and the monitoring of the condition of the two groups of patients were analyzed.The response of the two groups,the occurrence of adverse events and the prognosis of the two groups were compared.RESULTS The incidence of mechanical ventilation in the observation group was 28.3%,compared with 45.3%in the control group,the difference was not statistically significant,χ~2=3.295,P=0.070.In the observation group,the error intubation response time was(0.58±0.17)min,which was shorter than the control group of(2.11±0.42)min,t=24.583,P<0.001.The response time of the ventilator was(0.24±0.12)min,shorter than the control group of(0.88±0.15)min,t=24.255,P<0.001.Ventilator line discount or distortion response time was(1.05±0.34)min,shorter than the control group of(1.87±0.26)min,t=13.947,P<0.001.Insufficient ventilation response time was(4.12±0.78)min,shorter than the control group of(7.61±1.23)min,t=17.445,P<0.001.The rate of discharge was 98.11%,the mortality was 1.89%in the observation group,compared with 94.34%and 5.66%in the control group,the difference was not statistically significant,χ~2=0.139,0.266;P=0.308,0.610.CONCLUSION The application of end-tidal carbon dioxide oscillogram monitoring in the patients with mechanical ventilation in the PICU is significant,the adverse events of mechanical ventilation can be found in time and the prognosis of the patients is improved.