俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果

The application effect of prone position ventilation in children with sepsis combined with acute lung injury

目的 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2)),并计算动脉血氧分压与吸入气中的氧浓度分数比值(PaO_(2)/FiO_(2)),评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组(P<0.05),干预后两组患儿气道平台压、心率均降低,且观察组低于对照组(P<0.05);干预后两组患儿PaO_(2)/FiO_(2)、PaO_(2)水平升高,观察组高于对照组,PaCO_(2)降低,观察组低于对照组(P<0.05);干预后两组患儿全身性感染相关性器官功能衰竭评分(SOFA)、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分均降低,观察组低于对照组(P<0.05);两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义(P>0.05)。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。

Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury.Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children’s Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases.The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing.By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO_(2),PaO_(2),PaO_(2)/FiO_(2),the prognosis and occurrence of adverse events in the two groups were evaluated.Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group(P<0.05).After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group(P<0.05).After the intervention,the levels of PaO_(2)/FiO_(2) and PaO_(2) in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO_(2) was lower,with the observation group lower than the control group(P<0.05).After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group(P<0.05).There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups(P>0.05).Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis.