不同潮气量机械通气治疗儿童重症肺炎系统性评价

Systematic Review at Different Tidal Volume Mechanical Ventilation in the Treatment of Children with Severe Pneumonia

目的比较不同潮气量机械通气治疗儿童重症肺炎的疗效。方法将治疗的重症肺炎患儿120例按随机数字表分为3组,每组40例,均行机械通气治疗,A组潮气量为6~8ml/kg,B组为8~10ml/kg,C组为10~12ml/kg,比较3组呼吸力学参数变化,对患儿进行急性肺损伤(ALI)及小儿死亡危险(PRISMⅢ)评分,并比较3组静息能量消耗变化。结果撤机前A、B组肺动态顺应性(Cdyn)高于C组,C组气道阻力(AR)低于A、B组;A、B组ALI评分低于C组;撤机后C组静息能量消耗值高于A、B组,差异均有统计学意义(P<0.05)。结论不同潮气量机械通气对重症肺炎患儿呼吸功能的缓解作用相当,小潮气量、中潮气量机械通气对肺顺应性改善优于大潮气量,但大潮气量机械通气对机体的整体恢复较好。

Objective To compare the efficacy of different tidal volume mechanical ventilation in the treatment of children with severe pneumonia.Methods 120 children with severe pneumonia in January 2015 to June 2017 were randomly divided into 3 groups,40 cases in each group,all underwent mechanical ventilation,tidal volume of A group was 6~8 m L/kg,and B group was 8~10 m L/kg,C group was 10~12 m L/kg,compared respiratory mechanics parameters and evaluate acute lung injury（ALI）and pediatric risk of mortality（PRISMⅢ）scores,and compared changes in resting energy expenditure.Results Before withdrawal,dynamic lung compliance（Cdyn） of A group and B group were higher than that in the C group,and airway resistance（AR） in C group was lower than that in A group and B group;ALI scores in A group and B group were lower than that in C group;after withdrawal,resting energy expenditure in C group was higher than that in A group and B group,differences were statistically significant（P〈0.05）.Conclusions Different tidal volume mechanical ventilation in children with severe pneumonia,respiratory function is fairly,low and medium tidal volume are better at improving lung compliance than high tidal volume,but high tidal volume ventilation as a whole better recovery on patients.