肺泡-动脉氧分压差和氧合指数动态监测在小儿重症肺炎中的应用价值

Application Values of Dynamic Monitoring Alveolar-Arterial Oxygen Partial Pressure Difference and Oxygenation Index in Children with Severe Pneumonia

目的:探讨肺泡-动脉氧分压差(A-a DO2)和氧合指数(OI)动态监测在小儿重症肺炎中的应用价值。方法:选取2013年6月至2015年12月我院收治的重症肺炎患儿63例作为观察组,按照APACHE-Ⅱ评分分为观察组A(<20分)、观察组B(20分≤评分<40分)和观察C组(≥40分),另选取20例同期健康儿童作为对照组。比较观察组A、观察组B、观察组C以及对照组A-a DO2和OI水平。观察组所有患儿给予常规治疗,观察治疗后6 h、12 h、24 h和48 h A-a DO2和OI的动态变化。依据患儿预后情况将其分为存活组和死亡组,比较两组A-a DO2/体表面积和OI/体表面积水平。结果:观察组A、观察组B、观察组C和对照组A-a DO2/体表面积和OI/体表面积水平比较差异均有统计学意义(P<0.05),且每两组间也存在显著差异(P<0.05);治疗后各时间点观察组间A-a DO2/体表面积和OI/体表面积水平比较差异均有统计学意义(P<0.05),且每两个时间点间也存在显著差异(P<0.05);本组患儿病死率为11.11%,治疗前存活组A-a DO2/体表面积水平显著低于死亡组,而OI/体表面积水平显著高于死亡组,差异均有统计学意义(P<0.05)。观察组A、B、C病死率分别为5.00%、8.00%和22.22%。结论:A-a DO2和OI动态监测可以评估病情严重程度和预后,指导临床治疗,对死亡风险判断也有指示作用。

Objective： To explore the application values of dynamic monitoring alveolar-arterial oxygen partial pressure difference（ A-aDO_2） and oxygenation index（ OI） in children with severe pneumonia. Methods： Sixty-three cases of children with severe pneumonia in our hospital from June 2013 to December 2015 were selected as the observation group,who were divided into the observation A group（ 20 scores）,the observation B group（ ≥20 scores,and 40 scores） and the observation C group（ ≥40 scores）according to the APACHE-Ⅱ scores,and another 20 cases of healthy children with the same age were selected as the control group. The A-aDO_2 and OI levels of the observation A,B and C groups and the control group were compared. All children in the observation group were given conventional therapy,and the dynamic changes of the A-aDO_2 and OI levels after 6 h,12 h,24 h and 48 h of treatment were observed. The children were divided into survival group and death group according to the prognosis,and the A-aDO_2/ TBSA and OI / TBSA were compared. Results： There were significant differences in the A-aDO_2/ TBSA and OI / TBSA levels among the observation A,B and C groups and the control group（ P〈0. 05）,and between each two groups there were also significant differences（ P〈0. 05）. There were significant differences in the A-aDO_2/ TBSA and OI / TBSA levels among the four groups at every moment after treatment（ P〈0. 05）,and between each two time points there were also significant differences（ P〈0. 05）. The mortality rate of children was 11. 11%. The A-aDO_2/TBSA in the survival group before treatment was significantly lower than that in the death group,while the OI / TBSA was significantly higher than that in the death group（ P〈0. 05）. The mortality rates in the observation A group,observation B group and observation C group were respectively 5. 00%,8. 00% and 22. 22%. Conclusion： Dynamic monitoring of A-aDO_2 and OI levels can assess the severity of the disease and the effects of the prognosis,to guide treatment,which is also an indication to judge the risk of death.