俯卧位通气治疗小儿肺炎并发呼吸衰竭80例效果观察

Prone positioning in children with mechanical ventilation

目的:探讨俯卧位机械通气对肺炎并发呼吸衰竭患儿氧合和肺力学的影响。方法:对80例肺炎并发呼吸衰竭患儿采取自身对照的方法分别仰卧位-俯卧位各4h,共8h,记录并分析患儿呼吸机参数、动脉血气和肺力学改变。结果:在呼吸机参数改变无显著性差异的情况下,机械通气患儿进行自身对照,俯卧位4h的PO2较仰卧位4h高(70.93±13.36mmHg vs 66.43±11.86mmHg,P<0.05);俯卧位4h的氧合指数较仰卧位下降4.89±1.05vs5.20±1.14,P<0.05),俯卧位4h的肺泡动脉氧分压差较仰卧位减小(104.33±34.19mmHg vs121.80±36.40mmHg,P<0.05)。俯卧位4h的潮气量、每分钟通气量和肺动态顺应性与仰卧位4h相比有改善(P=0.002,0.023,0.001);俯卧位时气管阻力同仰卧位相比无显著性差异(P=0.060)。结论:机械通气患儿采取俯卧位时较传统仰卧位相比,可改善氧合、提高PO2和氧合指数及肺泡动脉氧分压差,并可增加每分钟通气量和潮气量,改善肺动态顺应性。

Objective ： To investigate the effects of prone positioning on oxygenation and lung mechanics in children suffering from pneumonia and respiratory failure with mechanical ventilation. Methods： Eighty cases of children , selected from the total hospital of Ningxia medical university（from January 2012 to December 2012）, Using own control, were placed in the supine position for 4h then in the prone position for 4h. The ventilator parameters, results of the lung mechanics and arterial blood gas were recorded. Results：Without obvious changes of ventilator parameters,PO2 improved significantly when the incubated children were placed in the prone position for 4h compared to supine （70.93±13.36mmHg vs 66.43±11.86mmHg,P〈0.05） Oxygenation index of prone positioning for 4h was4. 894- 1.05, which was lower than that of 5. 204-1.14, the value of supine positioning for 4h. There were significant differences （P〈0.05）. Similarly, A-aDO2 of prone positioning for 4h was lower than the value of supine positioning（104. 33±34.19mmHg vsl21. 80±36.40mmHg）and there were significant differences（P〈0.05）. Improvement in tidal volume, minute volume and dynamic compliance of the lung were achieved after prone positioning for 4h （P= 0. 002,0. 023,0. 001）. The airway resistance did not decrease significantly（P= 0. 060）. Conclusion： Oxygenation and the lung mechanics are improved significantly in the children with prone position compared with supine position.