机械通气序贯疗法在TOF患儿术后的应用体会

THE EFFECT OF SEQUENTIAL MECHANICAL VENTILATION IN PEDIATRIC PATIENTS WITH TETRALOGY OF FALLOT AFTER HEART SURGERY

目的探讨机械通气序贯疗法在法洛四联症(TOF)患儿心脏术后的应用效果。方法将90例TOF患儿随机分为治疗组(46例)和对照组(44例)。治疗组先应用压力调节容量控制通气(PRVC)模式常规呼吸机治疗,通气改善后尽早拔除气管插管,改用鼻塞持续气道正压通气(NC-PAP),而后过渡至自主呼吸;对照组应用常规机械通气,拔除气管插管后直接过渡到自主呼吸,比较两组的临床效果。结果治疗组术后PRVC时间、VAP发生率、再插管率明显低于对照组(P<0.05)。结论机械通气序贯疗法能有效缩短TOF患儿术后有创机械通气时间,减少呼吸机相关性肺炎和再次插管风险的发生。

Objective To investigate the effect of sequential mechanical ventilation on pediatric patients with tetralogy of Fallot（TOF） after heart surgery.Methods 90 patients with TOF were randomly divided into the therapy group（46 case） treated with convention mechanical ventilation（CMV） when the ventilation was improved and the control group（44 case）continuously receiving CMV and transited to spontaneous breathing.The tracheal intubation should be removed as early as possible,and the nasal continuous positive airway pressure（NCPAP） should be taken and the patients should be transited to spontaneous breathing.The therapeutic effect of both groups were compared.Results There was no statistical difference in total mechanical ventilation duration between both groups（P0.05）.The time of PRVC in the therapy group was shorter than that of the control group（P0.01）.The patients needing reintubation in the therapy group were less than in the control group（P0.05）.VAP occurrence rates showed significant difference（P0.01）.Conclusion The sequential mechanical ventilation can significantly reduce the length of invasive mechanical ventilation of pediatric patients with TOF after heart surgery,and can also reduce ventilator-associated pneumonia and the occurrence of reintubation.