俯卧位机械通气联合支气管镜肺泡灌洗对先天性心脏病术后ARDS患儿呼吸功能及预后的影响

Effect of prone mechanical ventilation combined with bronchoscopic alveolar lavage on respiratory function and prognosis of ARDS children after congenital heart disease

目的探讨俯卧位机械通气联合支气管镜肺泡灌洗对先天性心脏病(以下简称先心病)术后急性呼吸窘迫综合症(acute respiratory distress Syndrome,ARDS)患儿疗效及对呼吸动力学和血管内皮生长因子(VEGF)、巨噬细胞移动抑制因子(MIF)及降钙素原(PCT)的影响。方法采用病例对照研究设计,以2021年3月—2023年5月河南省人民医院收治的37例先心病术后ARDS患儿为研究组,患儿均进行了俯卧位机械通气联合支气管镜肺泡灌洗综合治疗。同期选择37例只实施俯卧位机械通气治疗的同病种患儿作为对照组,比较两组患儿治疗前(T1)、治疗24 h(T2)、治疗48 h(T3)的氧合指数(OI,OI=PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)及平均肺动脉压(MAP)水平等呼吸相关指标,检测VEGF、MIF及PCT水平变化,统计两组患儿治疗及预后情况。结果两组T1时间点OI、PaCO2、MAP指标比较无统计学意义(P>0.05),观察组T2、T3两个时间点OI为(254.37±24.43)mmHg及(342.3±16.94)mmHg,明显高于对照组,MAP为(68.53±3.20)mmHg及(62.17±2.26)mmHg,低于对照组(P<0.05),T2时间点,观察组PaCO2为(55.05±4.53)mmHg,低于对照组,但在T3时间点,两组PaCO2比较无统计学意义(P>0.05);两组T1时间点VEGF、MIF、PCT指标比较无统计学意义(P>0.05),T2、T3时间点均呈下降趋势,均低于T1时间点水平(P<0.05),且观察组T2、T3两个时间点VEGF、MIF、PCT水平均低于对照组(P<0.05);观察组的机械通气时间、吸痰次数、重症监护时间均短于对照组(P<0.05);两组的28d存活率、90d存活率比较差异均无统计学意义(P>0.05),但观察组的肺部感染发生率(37.84%)明显低于对照组(P<0.05)。结论俯卧位机械通气联合支气管镜肺泡灌洗有助于改善先心病术后ARDS患儿的呼吸功能,并有效促进肺功能康复的同时缩短机械通气时间,改善预后。

Objective To investigate the effects of prone mechanical ventilation combined with bronchoscopic alveolar lavage on acute respiratory distress syndrome(distress syndrome)after congenital heart disease(CHD)surgery.Effects of ARDS on respiratory dynamics,vascular endothelial growth factor(VEGF),macrophage migration inhibition factor(MIF)and procalcitonin(PCT).Methods A case-control study design was adopted.37 children with ARDS after congenital heart disease treated in Henan Provincial People's Hospital from March 2021 to May 2023 were selected as the study group.All the children underwent prone position mechanical ventilation combined with bronchoscopic alveolar lavage.At the same time choose 37 cases of the implementation of prone position mechanical ventilation treatment of the children of the same disease as control group,compared two groups of children before(T1),24 h treatment(T2),the treatment of 48 h(T3)oxygenation index(OI,OI=PaO_2/FiO_2),arterial partial blood carbon dioxide pressure(PaCO_2),mean pulmonary artery pressure(MAP)and other respiratory related indicators were detected,VEGF,MIF and PCT levels were measured,and the treatment and prognosis of the two groups were statistically analyzed.Results There was no statistical significance in OI,PaCO_2 and MAP indexes at T1 between the two groups(P>0.05).OI at T2 and T3 in the observation group were(254.37±24.43)mmHg and(342.3±16.94)mmHg,which were significantly higher than those in the control group.MAP values of(68.53±3.20)mmHg and(62.17±2.26)mmHg were lower than those of the control group(P<0.05),and PaCO_2 values of the observation group were(55.05±4.53)mmHg,lower than those of the control group,but at T3 time point,there was no significant difference in PaCO_2 between the two groups(P>0.05).There was no statistical significance in VEGF,MIF and PCT indexes between the two groups at T1 time points(P>0.05),while T2 and T3 time points showed a downward trend and were lower than T1 time points(P<0.05),and the levels of VEGF,MIF and PCT in the observation group were lower than those in the control group at T2 and T3 time points(P<0.05).The mechanical ventilation time,sputum aspiration times and intensive care time in observation group were shorter than those in control group(P<0.05).There was no significant difference in 28 d survival rate and 90 d survival rate between the two groups(P>0.05),but the incidence of pulmonary infection in the observation group(37.84%)was significantly lower than that in the control group(P<0.05).Conclusion Prone mechanical ventilation combined with bronchoscopic alveolar lavage can improve the respiratory function of ARDS children after congenital heart disease,effectively promote the recovery of lung function,shorten the time of mechanical ventilation,and improve the prognosis.