俯卧位通气在小儿肺炎肺不张中的应用
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Effect of mechanical ventilation in the prone position on children with pneumonia and atelectasis
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    目的:评价俯卧位通气对小儿肺炎肺不张的临床疗效-方法:2006年10月~2008年12月苏州大学附属儿童医院儿科重症监护病房收住的25例患儿,均因低氧血症行机械通气,通过胸部X线和CT诊断肺炎-肺不张,随机分成2组,仰卧位通气组和俯卧位通气组,通气模式为压力控制模式(PC mode),以监测呼出潮气量6~10 ml/kg反馈调节控制压力,吸气时间0.6~1.0 s,呼吸频率25~40次/min,吸入氧体积分数350~1 000 ml/L,呼气末正压5~12 cmH2O(1 cm H2O=0.098 kPa)-比较2组呼吸循环指标-影像学肺复张时间-机械通气时间-结果:俯卧位通气组的氧合指数(PaO2/FiO2)和动脉血氧分压(PaO2)显著高于仰卧位通气组(P < 0.05),俯卧位通气组的肺复张时间和机械通气时间显著少于仰卧位通气组(P < 0.05)-而心率-血压-动脉血二氧化碳分压-呼吸系统动态顺应性-呼吸道阻力-呼吸道峰压比较差异无统计学意义-结论:俯卧位通气可改善肺炎肺不张患儿的氧合,促进肺复张,减少机械通气时间-

    Abstract:

    Objective:To evaluate the clinical effect of mechanical ventilation in the prone position on children with pneumonia and atelectasis. Methods:Twenty-five patients with pneumonia and atelectasis admitted to Children’s Hospital Affiliated to Soochow University from Oct,2006 to Dec,2008,mechanically ventilated for hypoxemia,were divided into two groups:the supine position group and the prone position group. The ventilated mode was pressure control mode,regulating control pressure in order to keep expiratory tidal volume at 6~10 ml/kg level,setting inspiratory time(Ti)0.6~1.0 second,Respiratory rate(RR) 25~40 bpm,fraction of inspiratory oxygen(FiO2) 350~1000 ml/L,positive end-expiratory pressure(PEEP)5~12 cm H2O(1 cm H2O=0.098 kPa). Respiratory and circulatory indices,recovery time indicated by imaging,and ventilated time were assessed in the patients of two groups. Results:Oxygenation index(PaO2/FiO2) and pressure of artery oxygen(PaO2) of the prone position group were significantly higher than those in the supine position group(P < 0.05). Recovery time indicated by imaging and ventilated time of the prone position group were significantly less than those in the supine position group(P < 0.05),but there was no significant change in heart rate,blood pressure,pressure of artery CO2[Pa(CO2)],dynamic compliance,resistance of airway and peak of inspiratory pressure between the two groups. Conclusion:Mechanical ventilation in prone position can improve pulmonary gas exchange in children with pneumonia and atelectasis,and reduce recovery time indicated by imaging and ventilated time.

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柏振江,徐〓仑,封其华,谢敏慧,杜晓晨.俯卧位通气在小儿肺炎肺不张中的应用[J].南京医科大学学报(自然科学版),2010,(1):108-111

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  • 收稿日期:2009-07-27
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