小潮气量通气治疗急性低氧性呼吸衰竭患儿的效果及其相关因素研究

The Related Factors and the Effect of Low Tidal Volume Ventilation on Children with Acute Hypoxic Respiratory Failure

目的:探讨小潮气量通气治疗急性低氧性呼吸衰竭患儿的效果及其影响因素。方法:选取2018年1月至2019年12月100例急性低氧性呼吸衰竭患儿,基于随机数字表简单随机分为观察组(小潮气量通气方案治疗)与对照组(行常规通气方案治疗),各50例。比较两组治疗前后血气指标、血清炎症因子指标的变化以及治愈效果;基于观察治愈结果,采用单因素、及多因素logistic回归分析探讨影响小潮通气治疗治愈效果的高危因素。结果:上机时,两组PO2/FiO2、OI比较无显著差异(P>0.05),上机后24h、48h、72h,观察组PO2/FiO2明显高于,OI明显低于对照组,差异均具有统计学意义(P<0.05)。治疗前,两组IL-6、IL-8、TNF-α水平比较无显著差异(P>0.05),治疗后,观察组IL-6、IL-8、TNF-α水平均明显低于对照组,差异均具有统计学意义(P<0.05)。观察组治愈率(72.00%)明显高于对照组(42.00%),差异具有统计学意义(P<0.05)。单因素分析结果显示,观察组治愈与未治愈患儿年龄、发病至就诊时间、通气时间、急性肺损伤、脓毒症、重症肺炎等情况比较差异显著(P<0.05)。多因素Logistic回归分析,结果显示,年龄≤20个月、发病至就诊时间>3d、通气时间≤48h、有畸形肺损伤、有脓毒症为影响观察组治愈效果的独立性危险因素(P<0.05)。结论:小潮气量通气方案治疗急性低氧性呼吸衰竭患儿临床疗效显著,可改善血气指标,有效减轻炎性反应,利于患儿恢复;年龄≤20个月、发病至就诊时间>3d、通气时间≤48h、有畸形肺损伤、有脓毒症为影响小潮气量通气方案治愈效果的独立性危险因素,因此,可采取针对性干预措施,从而改善患儿预后。

Objective:To explore the related factors and the effect of small tidal volume ventilation in the treatment of children with acute hypoxic respiratory failure.Methods:100 children with acute hypoxic respiratory failure from January 2018 to December 2019 were selected and randomly divided into observation group(treated with low tidal volume ventilation)and control group(treated with conventional ventilation)based on random number table,with 50 cases in each group.The changes of blood gas index,serum inflammatory factor index and cure effect were compared between the two groups before and after treatment;based on the observation of cure results,univariate and multivariate logistic regression analysis was used to explore the high-risk factors affecting the cure effect of neap tide ventilation.Results:There was no significant difference in PO2/FiO2 and OI between the two groups(P>0.05)at the time of operation.At 24h,48h and 72h after the operation,the observation group had significantly higher PO2/FiO2 and OI was significantly lower than the control group.It has statistical significance(P<0.05).Before treatment,there was no significant difference in the levels of IL-6,IL-8 and TNF-αbetween the two groups(P>0.05).After treatment,the levels of IL-6,IL-8 and TNF-αin the observation group were significantly lower than those in the control group,The differences were statistically significant(P<0.05).The cure rate of the observation group(72.00%)was significantly higher than that of the control group(42.00%),the difference was statistically significant(P<0.05).The results of single factor analysis showed that there were significant differences in the age of cured and uncured children,the time from onset to presentation,ventilation time,acute lung injury,sepsis,and severe pneumonia in the observation group(P<0.05).Multivariate logistic regression analysis showed that age≤20 months,time from onset to visit>3d,ventilation time≤48h,deformed lung injury,and sepsis were independent risk factors that affected the curative effect of the observation group(P<0.05).Conclusion:The small tidal volume ventilation program has a significant clinical effect on children with acute hypoxic respiratory failure,which can improve blood gas indexes,effectively reduce inflammatory reactions,and facilitate the recovery of children;age≤20 months,time from onset to visit>3d,ventilation time≤48h,deformed lung injury,and sepsis are independent risk factors that affect the curative effect of the small tidal volume ventilation program.Therefore,targeted interventions can be taken to improve the prognosis of children.