常规治疗联合呼吸机辅助通气治疗小儿急性肺损伤的临床效果观察(1)
[摘要] 目的 探讨常规治疗联合呼吸机辅助通气治疗小儿急性肺损伤的临床效果。 方法 选取我院2009年1月～2014年10月收治的89例急性肺损伤患儿作为研究对象。所有患儿实施常规治疗、气管插管接呼吸机辅助通气治疗，统计临床治疗效果及患儿治疗前后的血气指标变化情况。 结果 89例患儿中治愈32例，好转52例，稳定3例，无效2例，总有效率为94.38%。患儿治疗后的血气指标变化水平优于治疗前，差异有统计学意义(P<0.05)。患儿治疗后的炎症指标水平低于治疗前，差异有统计学意义(P<0.05)。 结论 常规治疗联合气管插管接呼吸机辅助通气治疗小儿急性肺损伤的临床效果好，可以尽早纠正缺氧和改善组织供氧，有利于病情恢复；可显著改善患儿的血气指标，值得临床广泛推广应用。
[关键词] 呼吸机辅助通气；小儿急性肺损伤；效果
[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721(2015)06(c)-0029-03
[Abstract] Objective To explore the clinical effect of regular treatment combined with ventilator assisted ventilation in the treatment of pediatric acute lung injury. Methods 89 children with acute lung injury admitted into our hospital from January 2009 to October 2014 were selected as research subjects.All patients were given regular treatment，and assisted ventilation was also carried out via tracheal intubation connected to respirator.Clinical treatment effect and change of blood gas indices before and after the treatment were counted. Results 32 cases of 89 patients cured，52 improved， 3 stable and 2 ineffective，and the total effective rate was 94.38%.Change of blood gas indices after treatment were better than those before treatment，and the difference was statistically significant (P<0.05).Inflammation indices after treatment were lower than those before treatment，and the difference was statistically significant (P<0.05). Conclusion Regular treatment combined with mechanical ventilation via tracheal intubation connected to respirator in the treatment of pediatric acute lung injury has a favorable clinical effect.The treatment helps correct anoxia and improves tissue oxygen delivery timely，which is beneficial for disease recovery；the treatment can effectively improve patients′blood gas indices，which is worthy of clinical promotion and application.
[Key words] Ventilator assisted ventilation；Pediatric acute lung injury；Effect
有报道[1]指出，小儿急性肺损伤(acute lung injury，ALI)的临床治疗方法有控制原发病、呼吸机辅助通气、抗感染、提高氧合指数(PaO2/FiO2)、调节机体酸碱平衡等，研究结果显示呼吸机辅助通气是目前治疗小儿ALI的首选方法。本院从2009年1月开始研究小儿ALI应用呼吸机辅助通气的临床效果，现报道如下。
1 资料与方法
1.1 一般资料
选取本院2009年1月～2014年10月收治的89例ALI患儿作为研究对象，其中男性45例，女性44例；年龄3个月～11岁，平均(8.15±3.25)岁。所有患儿均符合ALI的临床诊断标准[2]：发病后病情进展迅速，呼吸频率显著增高或伴有呼吸窘迫症状，血氧量降低，PaO2/FiO2>300 mm Hg；X线检测双侧肺出现斑片状浸润性阴影；肺动脉压<18 mm Hg，但左心房压力正常。其中肺炎患儿20例，败血症21例，感染性休克16例，手足口病17例，溺水15例。上述患儿排除消化道出血及急性呼吸窘迫综合征者，心脑肾肝功能不全者，其他无法配合治疗者[2]。
1.2 治疗方法
所有患儿实施常规方法对症治疗[3]：吸氧、排痰、使用激素类药物扩张气道，调节机体酸碱平衡，病情危重者给予强心、利尿治疗。上述病例均行气管插管，接呼吸机辅助通气。通气模式设定压力控制同步间歇指令通气(SIMV)，呼吸频率(RR)为25～40/min，压力支持通气+呼气末正压(PEEP)3～12 H2O，脉冲(PIP)18～30 cm H2O，吸气时间(Ti)为0.5～0.8 s，心流(Flow)8～10 L/min。通气时间5～14 d。治疗过程中依据患儿症状改善情况适时调节呼吸机设置值，确保患儿动脉血氧饱和度>90%[4]。 (霍燕微等)
[关键词] 呼吸机辅助通气；小儿急性肺损伤；效果
[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721(2015)06(c)-0029-03
[Abstract] Objective To explore the clinical effect of regular treatment combined with ventilator assisted ventilation in the treatment of pediatric acute lung injury. Methods 89 children with acute lung injury admitted into our hospital from January 2009 to October 2014 were selected as research subjects.All patients were given regular treatment，and assisted ventilation was also carried out via tracheal intubation connected to respirator.Clinical treatment effect and change of blood gas indices before and after the treatment were counted. Results 32 cases of 89 patients cured，52 improved， 3 stable and 2 ineffective，and the total effective rate was 94.38%.Change of blood gas indices after treatment were better than those before treatment，and the difference was statistically significant (P<0.05).Inflammation indices after treatment were lower than those before treatment，and the difference was statistically significant (P<0.05). Conclusion Regular treatment combined with mechanical ventilation via tracheal intubation connected to respirator in the treatment of pediatric acute lung injury has a favorable clinical effect.The treatment helps correct anoxia and improves tissue oxygen delivery timely，which is beneficial for disease recovery；the treatment can effectively improve patients′blood gas indices，which is worthy of clinical promotion and application.
[Key words] Ventilator assisted ventilation；Pediatric acute lung injury；Effect
有报道[1]指出，小儿急性肺损伤(acute lung injury，ALI)的临床治疗方法有控制原发病、呼吸机辅助通气、抗感染、提高氧合指数(PaO2/FiO2)、调节机体酸碱平衡等，研究结果显示呼吸机辅助通气是目前治疗小儿ALI的首选方法。本院从2009年1月开始研究小儿ALI应用呼吸机辅助通气的临床效果，现报道如下。
1 资料与方法
1.1 一般资料
选取本院2009年1月～2014年10月收治的89例ALI患儿作为研究对象，其中男性45例，女性44例；年龄3个月～11岁，平均(8.15±3.25)岁。所有患儿均符合ALI的临床诊断标准[2]：发病后病情进展迅速，呼吸频率显著增高或伴有呼吸窘迫症状，血氧量降低，PaO2/FiO2>300 mm Hg；X线检测双侧肺出现斑片状浸润性阴影；肺动脉压<18 mm Hg，但左心房压力正常。其中肺炎患儿20例，败血症21例，感染性休克16例，手足口病17例，溺水15例。上述患儿排除消化道出血及急性呼吸窘迫综合征者，心脑肾肝功能不全者，其他无法配合治疗者[2]。
1.2 治疗方法
所有患儿实施常规方法对症治疗[3]：吸氧、排痰、使用激素类药物扩张气道，调节机体酸碱平衡，病情危重者给予强心、利尿治疗。上述病例均行气管插管，接呼吸机辅助通气。通气模式设定压力控制同步间歇指令通气(SIMV)，呼吸频率(RR)为25～40/min，压力支持通气+呼气末正压(PEEP)3～12 H2O，脉冲(PIP)18～30 cm H2O，吸气时间(Ti)为0.5～0.8 s，心流(Flow)8～10 L/min。通气时间5～14 d。治疗过程中依据患儿症状改善情况适时调节呼吸机设置值，确保患儿动脉血氧饱和度>90%[4]。 (霍燕微等)