不同潮气量机械通气治疗小儿重症肺炎疗效分析

Analysis of the therapeutic effects of mechanical ventilation with different tidal volume on the children with severe pneumonia.

目的观察应用不同潮气量机械通气治疗小儿重症肺炎的疗效差别。方法选择2009年1月至2010年6月收住吉林大学第一医院儿童重症监护室(PICU)进行机械通气治疗的小儿重症肺炎50例,根据潮气量的不同分为两组:小潮气量组(潮气量6～8mL/kg)25例,传统潮气量组(潮气量10～12mL/kg)25例,进行数据整理,观察机械通气后血气分析、呼吸机参数变化,观察其机械通气时间、病死率,对存活患儿随访呼吸系统症状。结果机械通气24h后传统潮气量组PaO2及氧合指数比值(P/F)较小潮气量组高,PaCO2、pH较小潮气量组低;机械通气时间传统潮气量组为(5.4±1.8)d,小潮气量组为(9.5±1.7)d;病死率传统潮气量组为16.0%,小潮气量组为32.0%。存活患儿反复呼吸道感染发生率传统潮气量为28.6%,小潮气量组为31.3%。结论传统潮气量机械通气治疗小儿重症肺炎的疗效优于小潮气量机械通气。

Objective To observe the therapeutic effects of mechanical ventilation with different tidal volume on the children with severe pneumonia.Methods Fifty child patients with severe pneumonia were given mechanical ventilation.These patients were randomized into two groups：one group used low tidal volume （6～8 mL/kg）,while the other group used conventional tidal volume （10～12 mL/kg）.Observe the changes of artery blood gas analysis after ventilation,time of mechanical ventilation and mortality.Follow up the respiratory system symptoms of survival patients.Results After 24 hours of mechanical ventilation,the PaO2 and P/F in conventional tidal volume group were higher than in low tidal volume group;PaCO2 and pH in conventional tidal volume group were lower than in low tidal volume group.The duration of mechanical ventilation in conventional tidal volume group was （5.4±1.8）d,while in low tidal volume group it was （9.5±1.7）d.The mortality of conventional tidal volume group was 16%,while in low tidal volume group it was 36%.Morbidity of survival patients with recurrent respiratory tract infection in conventional tidal volume group was 28.6%,while in low tidal volume group it was 31.3%.Conclusion Therapeutic effect of mechanical ventilation with conventional tidal volume is better than low tidal volume in the children with severe pneumonia.