重症肺炎患儿仰、俯卧位通气联合高频胸壁振荡排痰及超短波理疗的效果比较

Comparison of the efficacy of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration and ultrashort wave physiotherapy in children with severe pneumonia

目的:探讨仰、俯卧位通气联合高频胸壁振荡排痰及肺部超短波理疗(SW)对重症肺炎患儿氧合指标、痰液特点、血清细胞因子及临床症状改善的影响。方法:选取行机械通气的重症肺炎患儿60例,随机分为仰卧位通气组(SP组)、SP+SW组、俯卧位通气组(PP组)、PP+SW组,各15例。分别观察各组不同时点肺泡-动脉氧分压差、血氧分压、二氧化碳分压、脉搏血氧饱和度、氧合指数、气道内痰液黏稠度和痰液量及血清肿瘤坏死因子α、白细胞介素(IL)-2、IL-6、IL-10水平,以及各组发热时间、啰音消失时间、机械通气时间情况。结果:PP组、PP+SW组各时点动脉血氧分压、脉搏血氧饱和度、氧合指数均明显高于SP组和SP+SW组(P<0.01),肺泡-动脉氧分压差、二氧化碳分压均明显低于SP组和SP+SW组(P<0.01)。机械通气48、72 h,PP+SW组痰液排出量均明显低于其他3组(P<0.01)。PP+SW组24、48、72 h时肿瘤坏死因子α、IL-2、IL-6、IL-10水平均明显低于其他3组(P<0.01)。PP+SW组退热、肺部啰音消失、X线片病灶吸收和机械通气时长均明显低于其他3组(P<0.01)。结论:俯卧位通气下联合高频胸壁振荡排痰及SW能改善重症肺炎患儿氧合指标,降低气道痰液黏稠度并利于排痰,控制机体炎症免疫反应,促进临床症状恢复。

Objective:To investigate the effects of supine and prone position ventilation combined with high-frequency chest wall oscillation expectoration(HFCWO)and lung ultrashort wave physiotherapy(SW)on the improvement of oxygenation indexes,sputum characteristics,serum cytokines and clinical symptoms in children with severe pneumonia.Methods:Sixty children with severe pneumonia treated with mechanically ventilation were randomly divided into the supine position ventilation(SP)group,SP+SW group,prone position ventilation(PP)group and PP+SW group(15 cases each group).The alveolar arterial oxygen differential pressure,blood oxygen partial pressure,carbon dioxide partial pressure,pulse blood oxygen saturation,oxygenation index,sputum viscosity and sputum volume in airway,serum levels of tumor necrosis factorα,interleukin(IL)-2,IL-6,IL-10,fever time,rale disappearance time and mechanical ventilation time in each group were observed at different time points.Results:The arterial oxygen partial pressure,pulse oxygen saturation and oxygenation index in the PP and PP+SW groups were significantly higher than those in SP and SP+SW groups at all time points(P<0.01),and the alveolar artery oxygen partial pressure and carbon dioxide partial pressure in the PP and PP+SW groups were significantly lower than those in SP and SP+SW groups(P<0.01).After 48 and 72 h of mechanical ventilation,the sputum output in PP+SW group was significantly lower than that in other 3 groups(P<0.01).The levels of tumor necrosis factorα,IL-2,IL-6 and IL-10 in the PP+SW group at 24,48 and 72 h were significantly lower than those in other 3 groups(P<0.01).The duration of fever,lung rales,lesion absorption and mechanical ventilation in the PP+SW group were significantly lower than those in other 3 groups(P<0.01).Conclusions:Prone position ventilation combined with high-frequency chest wall oscillation expectoration and SW can improve the oxygenation index,reduce the viscosity of airway sputum,facilitate expectoration,control the body′s inflammatory and immune response,and promote the recovery of clinical symptoms in children with severe pneumonia.