不同俯卧位角度机械通气对实施床旁血滤急性呼吸窘迫综合征患儿的影响

Effect of mechanical ventilation with different prone position on children with acute respiratory distress syndrome under bedside blood filtration

目的分析30°与45°俯卧位机械通气对床旁血滤急性呼吸窘迫综合征(ARDS)患儿并发症及血流动力学的影响。方法收集因ARDS在该院实施床旁血滤并行俯卧位机械通气的89例患儿作为观察对象,根据入院时间先后将患儿分为甲组与乙组,其中甲组44例患儿俯卧位机械通气时抬高床头角度为45°,乙组45例患儿抬高床头30°行俯卧位机械通气。对比两组患儿机械通气后6、12 h的氧合指标包括动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)及血流动力学指标包括平均动脉压(MAP)及心率(HR),统计压疮、胃内容物反流(GER)及呼吸机相关性肺炎(VAP)发生率。结果乙组患儿机械通气后6、12 h PaO2及PaO2/FiO2水平均高于甲组(P<0.05);乙组的GER发生率较甲组低(P<0.05);两组机械通气后6、12 h的MAP与HR水平及压疮、VAP发生率对比差异无统计学意义(P>0.05)。结论30°俯卧位机械通气可提高ARDS床旁血滤患儿的氧合能力,降低压疮及GER发生的风险,值得应用。

【Objective】To analyze the effects of mechanical ventilation at 30°and 45°prone position on complications and hemodynamics in children with bedside hemofiltration-induced acute respiratory distress syndrome(ARDS).【Methods】Eightynine children with ARDS who underwent bedside hemofiltration and prone position mechanical ventilation in our hospital were enrolled.The children were divided into group A and group B according to the time of admission.Among them,44 patients in group A were prone in the case of mechanical ventilation,the bed angle was raised at 45°,and 45 patients in group B were raised in the prone position by mechanical ventilation at 30°.The oxygenation indexes at 6h and 12h after mechanical ventilation in the two groups included arterial oxygen partial pressure(PaO2),oxygenation index(PaO2/FiO2)and hemodynamic parameters including mean arterial pressure(MAP)and heart rate(HR).The incidence of pressure sores,gastric reflux(GER)and ventilator-associated pneumonia(VAP)were analyzed.【Results】After 6-hour,12-hour mechanical ventilation,the levels of PaO2 and PaO2/FiO2 in group B were higher than those in group A(P<0.05);the incidence of GER in group B was lower than that in group A(P<0.05);there was no significant difference in MAP,HR levels,pressure ulcer and VAP(P>0.05).【Conclusion】Mechanical ventilation at 30°prone position can improve the oxygenation capacity of children with ARDS at the bedside and reduce the risk of pressure ulcers and GER.It is worthy of application.