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目的探讨危重患儿呼吸衰竭应用小潮气量机械通气的临床效果。方法将84例急性呼吸衰竭患儿随机分为研究组(小潮气量通气组)和传统组(传统潮气量通气组),每组各42例,根据潮气量调整呼气末正压(PEEP)、吸气峰压(PIP)、平均气道压(MAP)。比较两组患者的临床疗效。结果治疗后两组的动态顺应性(Cdyn)、气道阻力(Rrs)、呼吸功(Wobv)、口腔闭合压(P0.1)在上机第0、1、3天比较差异均有统计学意义(P<0.05),第5、7天比较差异无统计学意义(P>0.05)。两组机械通气治疗前与治疗24 h后各项血气分析及氧合指标比较差异均有统计学意义(P<0.05)。治疗前两组各项指标比较差异未见统计学意义(P>0.05);治疗后两组各项指标差异有统计学意义(P<0.05)。研究组气压伤发生率显著低于传统组(P<0.05)。结论小潮气量机械通气对于危重患儿呼吸衰竭的临床疗效显著,能有效降低气压伤的发生率,更为安全。
Objective To investigate the clinical effect of low tidal volume mechanical ventilation in critically ill children with respiratory failure. Methods Eighty-four children with acute respiratory failure were randomly divided into study group (small tidal volume ventilation group) and traditional group (traditional tidal volume ventilation group), 42 cases in each group. PEEP was adjusted according to tidal volume, Peak inspiratory pressure (PIP), mean airway pressure (MAP). The clinical efficacy of the two groups was compared. Results After treatment, the differences of dynamic compliance (Cdyn), airway resistance (Rrs), Wobv, and oral closure pressure (P0.1) between the two groups were statistically significant (P <0.05). There was no significant difference on the 5th and 7th day (P> 0.05). Blood gas analysis and oxygenation index of two groups before mechanical ventilation and 24 h after treatment were significantly different (P <0.05). There was no significant difference between the two groups before treatment (P> 0.05). There was significant difference between the two groups after treatment (P <0.05). The incidence of barotrauma in study group was significantly lower than that in the traditional group (P <0.05). Conclusion Low tidal volume mechanical ventilation has significant clinical curative effect on respiratory failure in critically ill children, which can effectively reduce the incidence of barotrauma and is safer.