改良式俯卧位通气对ARDS患儿治疗的有效性和安全性系统评价

陈娟娟; 李莉; 孙琦; 张茜; 李冬梅

doi:10.16766/j.cnki.issn.1674-4152.003140

改良式俯卧位通气对ARDS患儿治疗的有效性和安全性系统评价

doi: 10.16766/j.cnki.issn.1674-4152.003140

蚌埠医学院第一附属医院儿童重症医学科，安徽蚌埠 233004

基金项目:

安徽省高校人文社会科学研究项目 SK2021A0425

蚌埠医学院人文社会科学类项目 BYKY2019205skZD

详细信息

通讯作者:
陈娟娟，E-mail：812475105@qq.com

中图分类号: R473.72 R725.6
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出版历程
- 收稿日期: 2022-07-18
- 网络出版日期: 2023-09-13

Systematic evaluation of the efficacy and safety of modified prone position ventilation in the treatment of children with ARDS

Department of Pediatric Intensive Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的观察改良式俯卧位通气对儿童急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)治疗的有效性和安全性，为临床ARDS的治疗和护理提供标准化流程。方法采用便利抽样法，选取2020年1月—2021年12月于蚌埠医学院第一附属医院儿童重症医学科住院的50例急性呼吸窘迫综合征患儿，采用随机数字表法随机分为对照组及观察组，各25例。对照组给予传统俯卧位通气方法，观察组给予改良式俯卧位通气方法，比较2组干预前后呼吸力学指标(氧合指数、胸肺顺应性)以及血流动力学指标(心率、平均动脉压)的改善及并发症发生情况。结果 2组俯卧位干预前呼吸力学指标以及血流动力学指标监测得分对比，差异无统计学意义(P＞0.05)；2组俯卧位通气后，血流动力学指标无明显改变，差异均无统计学意义(P＞0.05)；采取俯卧位通气后，观察组氧合指数、胸肺顺应性监测得分优于对照组，差异有统计学意义(均P＜0.05)。观察组并发症(压力性损伤，呕吐，意外脱管，颜面部水肿)的发生率为4.0%，对照组并发症发生率为48.0%，2组比较，差异有统计学意义(P＜0.05)。结论改良式俯卧位通气策略可促进ARDS患儿呼吸运动恢复，维持患儿血液动力学稳定，且减少了传统俯卧位造成的皮肤损伤、呕吐等并发症的发生，同时因改良俯卧位给予头面部有效支撑，缓解常规俯卧位引起的面部、眼睑或结膜水肿，减少并发症的发生，值得临床推广。
- 改良式俯卧位通气 /
- 早期 /
- 急性呼吸窘迫综合征 /
- 儿童
Abstract: Objective To observe the efficacy and safety of modified prone position ventilation in the treatment of children with acute respiratory distress syndrome (ARDS), to provide a standardized process for the treatment and care of clinical ARDS. Methods Fifty children with ARDS hospitalized in the Department of Intensive Care Medicine, the First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2021 were conveniently selected and randomly divided into control group and observation group by using a radom number table method, with 25 cases in each group. The control group was given the traditional prone position ventilation method, and the observation group was given the modified prone position ventilation method. The improvement of respiratory mechanical indexes (oxygenation index, thoracic and pulmonary compliance) and hemodynamic indexes (heart rate, mean arterial pressure) and the occurrence of complications before and after intervention were compared between the two groups. Results There was no significant difference in the scores of respiratory mechanics index and hemodynamic index between the two groups before intervention (P>0.05). After prone position ventilation, there were no significant changes in hemodynamic indexes between the two groups (P>0.05). The oxygenation index and chest and lung compliance monitoring scores of the observation group were better than those of the control group, and the differences were statistically significant (all P < 0.05). The incidence of complications (stress injury, vomiting, accidental extubation, facial edema) was 4.0% in the observation group and 28.0% in the control group, and the difference was statistically significant between the two groups (P < 0.05). Conclusion The modified prone position ventilation strategy can promote the recovery of respiratory movement, maintain the hemodynamic stability of children with ARDS, and reduce the occurrence of complications such as skin injury and vomiting caused by traditional prone position. Meanwhile, the modified prone position provides effective head and face support, alleviates the edema of face, eyelid or conjunctival caused by conventional prone position, and reduces the occurrence of complications. It is worthy of clinical promotion.
- Modified prone position ventilation /
- Early stage /
- Acute respiratory distress syndrome /
- Children

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图 1 改良式俯卧位通气垫“趴趴乐”

Figure 1. Modified prone position air cushion "Pake Ke Le"

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表 1 2组急性呼吸窘迫综合征患儿一般资料比较

Table 1. Comparison of general data of two groups of children with acute respiratory distress syndrome

组别	例数	性别[例(%)]		体重 [M(P₂₅, P₇₅)，kg]	年龄 [M(P₂₅, P₇₅)，岁]
组别	例数	男	女	体重 [M(P₂₅, P₇₅)，kg]	年龄 [M(P₂₅, P₇₅)，岁]
观察组	25	14(56.0)	11(44.0)	(7.75, 10.10)	(0.29, 2.00)
对照组	25	12(48.0)	13(52.0)	(8.45, 12.00)	(0.46, 2.50)
统计量		0.321^a		-1.175^b	-0.759^b
P值		0.571		0.240	0.448
注：^a为χ²值，^b为Z值。

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表 2 2组急性呼吸窘迫综合征患儿HR、MAP比较

Table 2. Comparison of HR and MAP between the two groups of ARDS children

组别	例数	HR(x±s，次/min)		t值	P值	MAP[M(P₂₅, P₇₅)，mmHg]		Z值	P值
组别	例数	俯卧位干预前	俯卧位干预后	t值	P值	俯卧位干预前	俯卧位干预后	Z值	P值
对照组	25	114.94±17.21	115.04±17.56	0.204	0.604	72.00(68.17, 83.17)	74.00(68.17, 84.67)	-1.429	0.153
观察组	25	115.54±16.40	115.80±16.00	0.049	0.961	72.00(68.50, 83.00)	74.00(67.17, 84.67)	-0.229	0.819
统计量		-0.111^a	0.160^a			-1.034^b	-1.848^b
P值		0.912	0.873			0.301	0.065
注：^a为t值，^b为Z值。

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表 3 2组急性呼吸窘迫综合征患儿PaO₂/FiO₂、Cst比较[M(P₂₅, P₇₅)]

Table 3. Comparison of PaO₂/FiO₂ and Cst in ARDS children between the two groups[M(P₂₅, P₇₅)]

组别	例数	PaO₂/FiO₂(mmHg)		Z值	P值	Cst(mL/cmH₂O)		Z值	P值
组别	例数	俯卧位干预前	俯卧位干预后	Z值	P值	俯卧位干预前	俯卧位干预后	Z值	P值
对照组	25	160.55(142.27, 171.66)	166.00(146.70, 199.11)	-2.247	0.025	37.20(32.55, 39.65)	38.10(34.50, 40.50)	-3.419	0.001
观察组	25	159.20(142.45, 168.65)	180.60(168.41, 194.89)	-4.049	＜0.001	36.40(32.80, 39.00)	41.50(39.95, 46.10)	-4.373	＜0.001
Z值		-1.546	-1.736			-1.816	-4.381
P值		0.122	0.043			0.069	＜0.001

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表 4 2组急性呼吸窘迫综合征患儿并发症发生情况比较

Table 4. Comparison of complications between the two groups of ARDS children [cases(%)]

组别	例数	呕吐	意外脱管	压力性损伤	颜面部水肿	合计
对照组	25	5(20.0)	3(12.0)	2(8.0)	2(8.0)	12(48.0)
观察组	25	1(4.0)	0	0	0	1(4.0)
注：2组并发症发生率比较，χ²=12.578，P＜0.001。

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