气道分级管理在新生儿急性肺损伤患儿机械通气期间的应用

Application of graded airway management during mechanical ventilation in neonates with acute lung injury

目的探讨气道分级管理在新生儿急性肺损伤患儿机械通气期间的应用。方法2016年6月~2018年6月选取该院新生儿科收治的急性肺损伤患儿84例,根据随机数字表法将患儿分为观察组和对照组,各42例。对照组行常规气道管理,每2 h行胸部物理治疗,观察组根据患儿气道评分情况实施气道分级管理。比较两组患儿治疗前、治疗后5 d急性生理与慢性健康评分(APACHEⅡ)、气血指标、机械通气时间、住院时间及并发症发生情况。结果观察组治疗后潮气量(VT)、呼吸频率(f)、血气氧分压值(PaO2)/氧气浓度(PaO2/FiO2)均较对照组显著改善,差异有统计学意义(均P<0.05);而APACHEⅡ评分较对照组显著下降,差异有统计学意义(P<0.05)。观察组机械通气时间、住院时间均短于对照组,差异有统计学意义(均P<0.05);而呼吸机相关肺炎发生率显著低于对照组,差异有统计学意义(P<0.05)。结论气道分级管理能有效改善新生儿急性肺损伤机械通气患儿的呼吸功能,降低患儿呼吸机相关肺炎发生率,促进患儿康复。

Objective To explore the application of graded airway management in mechanical ventilation of neonates with acute lung injury. Methods From June 2016 to June 2018, 84 cases of children with acute lung injury admitted to the neonatology department of this hospital were selected. According to the random number table method, the children were divided into the observation group and the control group, 42 cases of each group.The control group received routine airway management and chest physical therapy every 2 hours.The observation group received airway grading management according to the airway score of children.Acute physiological and chronic health scoreⅡ(APACHEⅡ), qi and blood indexes, mechanical ventilation time, hospital stay and complications were compared between the two groups before and 5 days after treatment. Results After treatment, tidal volume (VT), respiratory rate (f), and blood gas oxygen partial pressure (PaO2)/oxygen concentration (PaO2/FiO2) were significantly improved in the observation group compared with the control group, and the differences were statistically significant(P<0.05). APACHE Ⅱscore was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). Mechanical ventilation time and hospitalization time in observation group were shorter than those in control group, and the differences were statistically significant(P<0.05). The incidence of ventilator-associated pneumonia was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). Conclusions Airway grading management can effectively improve the respiratory function of children with mechanical ventilation in acute lung injury, reduce the incidence of ventilator-associated pneumonia in children, and promote the recovery of children.