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目的研究该院过去10 ～15年治疗急性肺损伤患儿分钟通气量( MV)的变化,讨论这些变化,尤其是潮气量( VT)对病死率的影响。设计回顾性研究。对象比较1988 ～1992年患儿(往年组,n=79)与2000 ～2004年患儿(近年组,n=85) MV变化情况。干预无。主要测量指标与结果与近年组比较,往年组所用VT均值明显高于近年组[(10.2±1.7) ml/kg vs (8.1±1.4) ml/kg,P<0.001] ,PEEP偏低[(6.1±2.7)cm H2O vs (7.1±2.4) cm H2O,P=0.007)] ,平均PIP亦较高[(31.5±7.3) dvs (27.8±4.2)cm H2O,P<0.001)]。近年组病死率较往年组低(21 % vs 35 %,P=0.04) ,不用呼吸机天数增加[(16.0±9.0) d vs (12.6±9.9) d,P=0.03)]。高VT与病死率增高(优势比OR:1.59 ;95 %可信区间CI :1.20 ,2.10 ,P<0.001)和不用呼吸机天数的减少独立相关(95 %可信区间CI :-1.24 ,-0.77 ,P<0.001)。结论本院临床实践中MV的变化与成人相似。根据我们的经验,急性肺损伤儿童的病死率下降了40 %,潮气量与病死率和不用呼吸机天数独立相关。
Objective To study the changes of minute ventilation (MV) in children with acute lung injury in the past 10 ~ 15 years and to discuss these changes, especially the influence of tidal volume (VT) on mortality. Design retrospective study. Subjects The changes of MV in children between 1988 and 1992 (n = 79 in previous years) and those in 2000 ~ 2004 (n = 85 in recent years) were compared. No intervention The main measurement indicators and results compared with recent years, the VT group in previous years was significantly higher than the recent group [(10.2 ± 1.7) ml / kg vs (8.1 ± 1.4) ml / kg, P <0.001], PEEP lower ± 2.7) cm H2O vs (7.1 ± 2.4) cm H2O, P = 0.007)], mean PIP was also higher (31.5 ± 7.3) dvs (27.8 ± 4.2) cm H2O, P <0.001). In recent years, the case fatality rate was lower than that in previous years (21% vs 35%, P = 0.04). The days without ventilator increased ([16.0 ± 9.0] d vs (12.6 ± 9.9) days, P = 0.03)]. High VT was independently associated with increased mortality (odds ratio OR 1.59; 95% confidence interval CI: 1.20, 2.10, P <0.001) and no reduction in ventilator days (95% CI: -1.24, -0.77 , P <0.001). Conclusion The changes of MV in clinical practice in our hospital are similar to those in adults. In our experience, the mortality rate for children with acute lung injury has dropped by 40% and tidal volume independently correlates with case fatality and days without ventilator.