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目的探讨小潮气量(VT)和传统VT机械通气在急性低氧性呼吸衰竭(AHRF)治疗中的安全性的差异,评估小VT通气策略的疗效。方法将133例AHRF患儿分为传统VT通气组32例和小VT通气组101例,根据VT调整呼气末正压(PEEP),监测肺动态顺应性(Cdyn)、呼吸功(WOB)、呼吸道阻力(Raw)、呼吸道闭合压(P0.1)、肺泡气-动脉血氧分压差[p(A-a)(O2)]、氧合指数(OI)、血气分析等指标变化,观察患儿氧合改善情况、机械通气并发症发生、撤机情况以及患儿转归情况。结果 1.小VT组与传统VT组,Cdyn、Raw在上机1 d、3 d,WOB在上机3 d、5 d,P0.1在上机5 d、7 d比较差异均有统计学意义(Pa<0.05)。小VT通气24 h氧合改善较传统VT通气明显,pa(O2)、p(A-a)(O2)、OI比较差异均有统计学意义(Pa<0.05)。2.小VT组呼吸机相关性肺损伤发生率明显低于传统VT组,差异有统计学意义(P<0.05)。3.危重患儿病死率比较无明显差异。结论 Cdyn、Raw、WOB、P0.1等呼吸力学指标有助于判断机械通气过程中患儿肺部病变情况,及时调整呼吸机参数并判断撤机时机。在降低呼吸机相关性肺损伤的发生方面,小VT通气优于传统VT通气。小VT通气在降低AHRF患儿病死率方面,并不优于传统VT通气。
Objective To investigate the difference of safety between small tidal volume (VT) and traditional VT ventilation in the treatment of acute hypoxic respiratory failure (AHRF) and to evaluate the curative effect of small VT ventilation strategy. Methods 133 children with AHRF were divided into two groups: traditional VT ventilation group (n = 32) and small VT ventilation group (n = 101). VTEP was used to monitor the dynamic compliance (Cdyn) Respiratory tract pressure (Raw), airway pressure (P0.1), alveolar gas-arterial partial pressure of oxygen [p (Aa) O2), oxygenation index (OI), blood gas analysis and other indicators were observed in children Oxygenation improved, mechanical ventilation complications, weaning conditions and the outcome of children. Results 1. Small VT group and traditional VT group, Cdyn, Raw on the machine 1 d, 3 d, WOB on the machine 3 d, 5 d, P0.1 on the machine 5 d, 7 d were statistically significant differences Significance (Pa <0.05). The improvement of oxygenation after 24 h of small VT ventilation was more obvious than that of the traditional VT. Pa (O2), p (A-a) (O2) and OI had statistical significance (P0.05). The incidence of ventilator-associated lung injury in small VT group was significantly lower than that in the traditional VT group, the difference was statistically significant (P <0.05). 3. Critically ill children mortality no significant difference. Conclusion Respiratory mechanics indexes such as Cdyn, Raw, WOB and P0.1 are helpful to judge the pulmonary lesions in children during mechanical ventilation, adjust ventilator parameters timely and judge the timing of weaning. Small VT ventilation is superior to traditional VT ventilation in reducing the incidence of ventilator-associated lung injury. Small VT ventilation is not superior to traditional VT ventilation in reducing mortality in children with AHRF.