俯卧位通气对小儿急性肺损伤的疗效

Curative Effect of Prone Position Ventilation on Acute Lung Injury in Children

目的评价俯卧位通气对小儿急性肺损伤(ALI)的临床疗效。方法2006年5月-2007年12月苏州大学附属儿童医院儿科重症监护病房收住的17例ALI患儿,在持续镇静下俯卧位通气4h,机械通气模式为压力控制模式(PCmode),以监测呼出潮气量6～8mL/kg反馈调节控制压力,吸气时间0.6～1.0s,呼吸频率28～42次/min,吸入氧体积分数400～1000mL/L,呼气末正压6～16cmH2O(1cmH2O=0.098kPa)。监测0、1、4h及恢复仰卧位通气4h的呼吸循环指标,并进行比较。采用SPSS13.0软件进行统计学分析。结果在实施俯卧位通气1、4h及恢复仰卧位通气4h,氧合指数[pa(O2)/FiO2]和pa(O2)均较实施俯卧位通气前显著升高(Pa<0.05),俯卧位通气4h和恢复仰卧位通气4h时的尿量也有增加(Pa<0.05)。而心率、平均动脉血压、动脉血二氧化碳分压、呼吸系统动态顺应性、呼吸道阻力、呼吸道峰压等比较差异均无统计学意义。结论俯卧位通气可改善ALI患儿的氧合,增加尿量,恢复仰卧位通气后氧合改善,尿量增加仍持续存在。

Objective To evaluate the clinical efficacy of prone position ventilation on acute lung injury （ALI） in children. Methods Seventeen children with ALI admitted to Children＇s Hospital Affiliated to Soochow University from May. 2006 to Dec. 2007 ,were mechanically ventilated in prone positioning for 4 hours with continuous infusion of sedation. The ventilation mode was pressure control mode, regulating control pressure in order to keep expiratory tidal volume at 6 - 8 mL/kg level, setting inspiratory time （ Ti ） 0.6 - 1.0 second, respiratory rate （RR） 28 -42 bpm,fraction of inspiratory oxygen（ FiO2 ）400 - 1 000 mL/L,positive end - expiratory pressure（ PEEP）6 - 16 cmH2O（ 1 cmH2O = 0. 098 kPa）. The respiratory and circulatory indices were measured and recorded at 0,1,4 hours after prone positioning and 4 hours after supine positioning was resumed. SPSS 13.0 software was used to analyze the data. Results Oxygenation index [ Pa （ O2 ）/FiO2 ] and Pa （ O2 ） were significantly increased at 1,4 hours after prone position ventilation was performed and 4 hours after supine positioning was resumed（ Pa 〈 0.05 ）. Urine output increased at 4 hours after prone position ventilation was performed and 4 hours after supine positioning was resumed （ Pa 〈 0.05 ）. But there was no significant change in heart rate, mean artery pressure, pressure of artery CO2 [ pa（ CO2 ） ] , dynamic compliance, resistance of airway and peak of inspiratory pressure. Conclusions Prone position ventilation can improve pulmonary gas exchange and urine output in children with acute lung injury ,even after supine positioning is resumed.