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目的探讨不同潮气量机械通气对重症肺炎患儿肺泡动脉氧分压差的影响。方法将邢台市第三医院收治的100例全麻下行气管插管治疗的重症肺炎患儿随机分为研究组和对照组,每组50例。对照组给予小潮气量(6~8 ml/kg)机械通气,研究组给予大潮气量(10~12 ml/kg)机械通气,比较两组治疗效果、血气指标变化、并发症发生率及病死率。结果研究组患儿治疗总有效率为82.00%,显著高于对照组的58.00%(P<0.05)。治疗前两组患儿动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、肺泡动脉氧分压差(A-aDO_2)、pH、HCO_3~-、碱剩余(BE)水平差异无统计学意义(P>0.05),治疗后除对照组HCO_3~-无明显变化外,其余均显著改善(P<0.05),研究组优于对照组(P<0.05)。研究组机械通气时间、临床治疗总时间、肺功能恢复正常时间较对照组显著缩短(P<0.05)。研究组并发症发生率、死亡率分别为14.00%、8.00%,显著低于对照组36.00%、26.00%(P<0.05)。结论大潮气量机械通气可以有效降低重症肺炎患儿肺泡动脉氧分压差,提高治疗总有效率,缩短治疗时间,降低并发症发生率和死亡率。
Objective To investigate the effect of different tidal volume mechanical ventilation on pulmonary arterial oxygen pressure difference in children with severe pneumonia. Methods 100 cases of severe pneumonia treated by general anesthesia with endotracheal intubation in the Third Hospital of Xingtai City were randomly divided into study group and control group, with 50 cases in each group. The control group was given mechanical ventilation with low tidal volume (6-8 ml / kg). The study group was given mechanical ventilation with high tidal volume (10-12 ml / kg). The therapeutic effect, changes of blood gas index, complication rate and mortality were compared between the two groups. Results The total effective rate of treatment children was 82.00% in study group, which was significantly higher than that in control group (58.00%, P <0.05). PaO2, PaCO 2, A-aDO 2, pH, HCO 3 -, and the level of basic excess (BE) in the two groups before treatment were significantly different (P <0.05). After treatment, HCO 3 ~ - in the control group showed no significant change except the control group (P <0.05). The study group was superior to the control group (P <0.05). The time of mechanical ventilation, the total time of clinical treatment and the recovery of lung function in study group were significantly shorter than those in control group (P <0.05). The complication rate and mortality in the study group were 14.00% and 8.00%, respectively, which were significantly lower than those in the control group (36.00% and 26.00%, P <0.05). Conclusions Large tidal volume ventilation can effectively reduce the partial pressure of oxygen in alveolar artery in children with severe pneumonia, increase the total effective rate of treatment, shorten the treatment time and reduce the incidence of complications and mortality.