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目的 :探讨不同潮气量通气策略对小儿急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患儿预后的影响。方法 :根据潮气量不同将我院诊治的ALI/ARDS患儿102例分为2组:传统潮气量组(10~12 m L/kg潮气量)51例,小潮气量组(6~8 m L/kg潮气量)51例。观察并比较2组机械通气后血气分析变化、呼吸机参数变化,记录2组机械通气时间、住PICU时间、住院时间、病死率。结果 :通气后24 h,2组PaO_2、pH及SaO_2较通气即刻升高、PaCO_2较通气即刻降低,且小潮气量组PaO_2、pH及SaO_2高于传统潮气量组、PaCO_2低于传统潮气量组。通气0 d、1 d、3 d小潮气量组VT、MAP、PEEP、PIP呼吸机参数较同时间传统潮气量组较低、FiO_2比较差异无统计学意义。小潮气量组机械通气时间、住RICU时间、住院时间、病死率均小于传统潮气量组,2组不良反应发生率比较差异无统计学意义。结论 :小潮气量通气策略治疗小儿ALI/ARDS预后效果可能优于传统潮气量通气策略,值得进一步探究。
Objective: To investigate the effect of different tidal volume ventilation strategies on the prognosis of children with acute lung injury (ALI) / acute respiratory distress syndrome (ARDS). Methods: According to the tidal volume, 102 children with ALI / ARDS diagnosed and treated in our hospital were divided into two groups: traditional tidal volume (10-12 m L / kg tidal volume), small tidal volume (6-8 m L / kg tidal volume) 51 cases. The changes of blood gas analysis and changes of ventilator parameters were observed and compared after 2 groups of mechanical ventilation. The time of mechanical ventilation, the time of PICU, the length of stay and the case fatality rate were recorded. Results: PaO2, pH and SaO 2 instantly increased immediately after ventilation, PaCO 2 immediately decreased compared with ventilation, and PaO 2, pH and SaO 2 of the low tidal volume were higher than the traditional tidal volume, PaCO 2 was lower than the traditional tidal volume. Ventilation VT, MAP, PEEP, PIP ventilator parameters of 0 t, 1 d, 3 d ventilation group were lower than the traditional tidal volume group at the same time, FiO 2 was no significant difference. Small tidal volume of mechanical ventilation time, living in RICU time, hospital stay, mortality were less than the traditional tidal volume, the incidence of adverse reactions was no significant difference between the two groups. CONCLUSION: The effect of small tidal volume ventilation strategy in the treatment of pediatric ALI / ARDS may be superior to the traditional tidal volume ventilation strategy and is worth exploring further.