高频振荡机械通气治疗儿童急性呼吸窘迫综合征的临床效果研讨

Study on the Clinical Effect of High-frequency Oscillatory Mechanical Ventilation in the Treatment of Children with Acute Respiratory Distress Syndrome

目的研讨采取高频振荡机械通气(HFOV)对儿童急性呼吸窘迫综合征(ARDS)进行治疗的效果。方法择取2016年1月—2020年6月该院儿科接收的100例ARDS患儿为观察对象,依照治疗方案的不同将这些患儿分别列入研究组与传统组,每组50例,两组均行常规急救措施,此基础上,传统组实施常频机械持续控制通气治疗,研究组实施高频振荡机械通气治疗,统计两组患儿治疗后存活率及胸片恢复正常时间、机械通气时间、ICU留置时间;同时监测两组机械通气治疗前、治疗72 h后氧合功能参数(PaO2、PaCO2、OI)及炎症因子(hs-CRP、PCT、IL-6、TNF-α)水平。结果两组患儿存活率比较差异无统计学意义(P>0.05)。研究组存活患儿的胸片恢复正常时间、机械通气时间、ICU留置时间分别为(2.6±1.52)、(4.7±1.29)、(19.5±5.28)d,传统组存活患儿的分别为(4.9±1.46)、(6.9±1.17)、(27.4±4.86)d,研究组存活患儿的胸片恢复正常时间、机械通气时间、ICU留置时间都显著短于传统组,差异有统计学意义(t=7.477、8.649、7.539,P=0.007、0.003、0.006)。机械通气治疗前,两组存活患儿的氧合功能参数和炎症因子水平比较,差异无统计学意义(P>0.05);机械通气治疗72 h后,研究组存活患儿的PaO2、PaCO2、OI水平分别为(8.79±0.49)kPa、(5.62±0.39)kPa、(8.52±2.33),传统组存活患儿的PaO2、PaCO2、OI水平分别为(7.81±0.46)kPa、(6.24±0.27)kPa、(12.83±2.64),即研究组存活患儿的氧合功能参数都较传统组显著改善,差异有统计学意义(t=9.987、8.925、8.401,P=0.000、0.002、0.003);治疗后,研究组存活患儿的hs-CRP、PCT、IL-6、TNF-α水平分别为(70.35±28.29)mg/L、(11.24±4.25)g/L、(30.28±9.26)g/L、(10.42±4.92)g/L,传统组存活患儿的hs-CRP、PCT、IL-6、TNF-α水平分别为(105.64±28.71)mg/L、(19.62±6.04)g/L、(41.76±9.23)g/L、(16.74±4.96)g/L,即研究组存活患儿各项炎症因子水平都显著低于传统组,差异有统计学意义(t=6.002、7.806、6.018、6.201,P=0.009、0.004、0.009、0.008)。结论将HFOV用于ARDS患儿治疗中,能较快改善其氧合指数,缓解缺氧状况,同时可拮抗炎症反应,有助于缩短治疗时间,效果较理想。

Objective To study the effect of high frequency oscillatory mechanical ventilation(HFOV)on the treatment of acute respiratory distress syndrome(ARDS)in children.Methods A total of 100 children with ARDS received from the Department of Pediatrics in the hospital from January 2016 to June 2020 were selected as observation objects.These children were included in the research group and the traditional group according to different treatment plans,with 50 cases in each group,two groups were treated with routine first aid measures.On this basis,the traditional group was treated with constant-frequency mechanical continuous controlled ventilation,and the research group was treated with high-frequency oscillatory mechanical ventilation.The survival rate of the two groups of children after treatment and the time for chest radiographs to return to normal were counted,as well as the mechanical ventilation time,ICU indwelling time;simultaneously monitor the oxygenation function parameters(PaO2,PaCO2,OI)and inflammatory factors(hs-CRP,PCT,IL-6,TNF-α)levels before and 72 hours after treatment with mechanical ventilation in the two groups.Results There was no statistically significant difference in survival rates between the two groups(P>0.05).The recovery time of chest radiograph,mechanical ventilation time and ICU indwelling time of the surviving children in the research group were(2.6±1.52)d,(4.7±1.29)d,and(19.5±5.28)d,respectively.The surviving children in the traditional group were respectively(2.6±1.52)d,(4.7±1.29)d,and(19.5±5.28)d.(4.9±1.46)d,(6.9±1.17)d,(27.4±4.86)d,the recovery time of chest radiograph,mechanical ventilation time and ICU indwelling time of the surviving children in the research group were significantly shorter than those in the traditional group,the difference was statistically significant(t=7.477,8.649,7.539,P=0.007,0.003,0.006).Before mechanical ventilation treatment,the oxygenation function parameters and inflammatory factor levels of the two groups of surviving children were not statistically significantly different(P>0.05);72 hours after mechanical ventilation treatment,the PaO2,PaCO2,and OI levels of the surviving children in the research group were respectively(8.79±0.49)kPa,(5.62±0.39)kPa,(8.52±2.33),the PaO2,PaCO2,and OI levels of the surviving children in the traditional group were(7.81±0.46)kPa,(6.24±0.27)kPa,(12.83±2.64),that is,the oxygenation function parameters of the surviving children in the research group were significantly improved compared with the traditional group,the difference was statistically significant(t=9.987,8.925,8.401,P=0.000,0.002,0.003);after treatment,the hs-CRP,PCT,IL-6 and TNF-αof the surviving children in the research group were(70.35±28.29)mg/L,(11.24±4.25)g/L,(30.28±9.26)g/L,(10.42±4.92)g/L,the hs-CRP,PCT,IL-6,and TNF-αlevels of the surviving children in the traditional group were(105.64±28.71)mg/L,(19.62±6.04)g/L,(41.76±9.23)g/L,(16.74±4.96)g/L,that is,the levels of various inflammatory factors in the research group were significantly lower than those in the traditional group,the difference was statistically significant(t=6.002,7.806,6.018,6.201,P=0.009,0.004,0.009,0.008).Conclusion The use of HFOV in the treatment of children with ARDS can quickly improve their oxygenation index,alleviate hypoxia,and at the same time antagonize inflammation,help shorten the treatment time,and the effect is ideal.