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目的:观察小剂量糖皮质激素联合小潮气量、肺复张(RM)治疗重症肺炎肺损伤患儿的临床有效性及安全性。方法:入住我院PICU符合重症肺炎肺损伤患儿42例,随机分为试验组和对照组各21例,所有入选患儿均给予常规治疗、小剂量糖皮质激素,试验组入院24 h内给予小潮气量(VT:6~8 m L/kg)机械通气和RM,对照组只给予机械通气(VT:8~10 m L/kg)。分析两组患儿血流动力学、呼吸力学、血气变化、预后及并发症。结果:试验组患儿在小剂量糖皮质激素、小潮气量基础上共进行RM操作73例次,RM后5 min、15 min、60 min气道峰压、呼吸频率、呼气末压力、吸气氧体积分数、平均气道压水平均低于RM前(P<0.05);呼吸频率、平均动脉压RM前后比较差异无统计学意义(P>0.05);两组血气分析均较通气前改善(P<0.05);通气后两组患儿Pa O2/Fi O2、肺动态顺应性、呼气功比较差异有统计学意义(P<0.05);试验组机械通气时间、吸氧时间、住院时间均较对照组短,并发症较对照组减少(P<0.05)。结论:小剂量糖皮质激素联合小潮气量、RM可以改善重症肺炎肺损伤患儿氧合功能,提高患儿肺的顺应性,患儿耐受性良好,能缩短患儿机械通气时间、氧暴露时间、住院时间,减少不良反应。
Objective: To observe the clinical efficacy and safety of low dose glucocorticoid combined with small tidal volume and pulmonary reexpansion (RM) in children with severe pneumonia and lung injury. Methods: Forty-two children with severe pneumonia admitted to our hospital were randomly divided into experimental group and control group (n = 21). All children were enrolled in routine therapy and received low-dose glucocorticoid. The experimental group was given within 24 h Mechanical ventilation and RM were performed with low tidal volume (VT: 6-8 m L / kg) and mechanical ventilation (VT: 8-10 m L / kg) in the control group. Analysis of two groups of children with hemodynamics, respiratory mechanics, blood gas changes, prognosis and complications. Results: In the experimental group, 73 cases of RM operation were performed on the basis of low dose glucocorticoid and small tidal volume, peak airway pressure, respiratory rate, end-expiratory pressure, inspiratory pressure at 5 min, 15 min and 60 min after RM (P <0.05). There was no significant difference in respiratory rate and mean arterial pressure between before and after RM (P> 0.05). The blood gas analysis in both groups was better than that before ventilation (P < P <0.05). PaO2 / Fi O2, pulmonary dynamic compliance and expiratory work were significantly different between the two groups after ventilation (P <0.05). The duration of mechanical ventilation, oxygen inhalation and hospital stay Compared with the control group, the complication rate was lower than that of the control group (P <0.05). Conclusion: Low dose glucocorticoids combined with low tidal volume, RM can improve the oxygenation function of children with severe pneumonia and lung injury and improve lung compliance in children with good tolerance, can shorten the mechanical ventilation time, oxygen exposure time , Hospital stay, reduce adverse reactions.