不同潮气量机械通气对重症肺炎患儿肺泡动脉氧分压差的影响

Effects of different tidal volume ventilation on alveolar-arterial oxygen partial pressure difference in children with severe pneumonia

目的探讨不同潮气量机械通气对重症肺炎患儿肺泡动脉氧分压差的影响。方法将邢台市第三医院收治的100例全麻下行气管插管治疗的重症肺炎患儿随机分为研究组和对照组,每组50例。对照组给予小潮气量(6~8 ml/kg)机械通气,研究组给予大潮气量(10~12 ml/kg)机械通气,比较两组治疗效果、血气指标变化、并发症发生率及病死率。结果研究组患儿治疗总有效率为82.00%,显著高于对照组的58.00%(P<0.05)。治疗前两组患儿动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、肺泡动脉氧分压差(A-aDO_2)、pH、HCO_3^-、碱剩余(BE)水平差异无统计学意义(P>0.05),治疗后除对照组HCO_3^-无明显变化外,其余均显著改善(P<0.05),研究组优于对照组(P<0.05)。研究组机械通气时间、临床治疗总时间、肺功能恢复正常时间较对照组显著缩短(P<0.05)。研究组并发症发生率、死亡率分别为14.00%、8.00%,显著低于对照组36.00%、26.00%(P<0.05)。结论大潮气量机械通气可以有效降低重症肺炎患儿肺泡动脉氧分压差,提高治疗总有效率,缩短治疗时间,降低并发症发生率和死亡率。

Objective To explore the effects of different tidal volume ventilation on alveolar-arterial oxygen partial pressure difference in children with severe pneumonia. Methods 100 cases of children with severe pneumonia who were treated with tracheal intubation under general anesthesia were randomly divided into observation group and control group, with 50 cases in each group. The control group was given low tidal volume mechanical ventilation（ 6 -8 ml / kg） for treatment, and the observation group were given high tide volume mechanical ventilation（10 -12 ml / kg） for treatment. The treatment effect,changes of blood gas indexes and incidence rated of complications and mortality were compared between the two groups.Results The total effective rate in the observation group was 82.00%, significantly higher than that of 58.00% in the control group（P〈0.05）. Before treatment, the differences in PaO2, PaCO2, A-aDO2, pH, HCO3^-, and BE levels were not statistically significant between the two groups（P 〉0.05）; after treatment all the indexes except for HCO3^- were significantly increased（P〈0.05）, and those in the study group were better than those in the control group（P〈0.05）. The mechanical ventilation time, total time of clinical treatment and pulmonary function recovery time of the observation group were significantly lower than those of the control group（P〈0.05）. The incidence rate of complications and mortality of the observation group were respectively 14.00% and 8.00%, signifciantly lower than those of 36.00% and 26.00% of the control group（ P〈0.05）.Conclusion High tidal volume ventilation can effectively decrease alveolar-arterial oxygen partial pressure difference in children with severe pneumonia, improve the total effective rate, shorten the treatment time and reduce the incidence rate of complications and mortality.