俯卧位通气法在PICU呼吸窘迫综合征中的应用效果

Application of prone-position ventilation on children with respiratory distress syndrome in the PICU

目的探讨俯卧位通气法对儿科重症监护室(pediatric intensive care unit,PICU)呼吸窘迫综合征(respiratory distress syndrom,RDS)患儿的影响。方法选取2018年6月-2019年9月入住PICU呼吸窘迫综合征患儿作为研究对象,采用随机数字表法将其分为观察组30例和对照组23例。对照组予以仰卧位—左右侧卧位交替体位变换,观察组予以俯卧位—仰卧位—俯卧位—左右侧卧位轮流体位变化。分别观察并比较2组患儿机械通气后4、12、24、48、72 h氧合指数(OI)和血气分析指标(PaO_(2)、PaCO_(2)、SaO_(2));同时比较血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)],以及预后情况。结果2组OI、PaCO_(2)、PaO_(2)、SaO_(2)在时间、组间、交互效应上比较,差异均有统计学有意义(P<0.05);2组HR、MAP比较,差异均无统计学意义(P>0.05)。观察组机械通气时间短于对照组(t=6.672,P=0.021),2组病情好转率比较,差异无统计学意义(χ^(2)=0.190,P=0.663)。结论俯卧位通气法可有效改善RDS患儿的氧合状况,缩短RDS机械通气时间,改善预后。

Objective To explore the effect of prone-position ventilation on children with respiratory distress syndrome(RDS)in pediatric intensive care unit(PICU).Methods RDS children admitted to PICU between June_(2)018 and September_(2)019 were divided into an observation group of 30 and a control group of_(2)3 according to a random table.The control group remained supine and bilateral side-lying positions alternately,while the observation group kept prone position-supine position-prone position-bilateral side-lying position in turns.The oxygenation index(OI)and blood gas analysis indicators of partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))and arterial oxygen saturation(SaO_(2))were observed and compared 4,12,24,48 and 72 hours after the mechanical ventilation.Meanwhile,hemodynamic parameters such as the heart rate(HR)and mean arterial pressure(MAP),as well as the prognosis were compared.Results The OI,PaO_(2),PaCO_(2) and SaO_(2) were of significant differences in the time,inter-group and interaction effect(P<0.05).However,no significant differences were found between the two groups in the HR and MAP(P>0.05).The mechanical ventilation time of the observation group was shorter than that of the control group(t=6.672,P=0.021).Conclusion Prone-position ventilation can effectively improve the oxygenation status and shorten the mechanical ventilation time.