Clinical application of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome
-
摘要:目的
观察俯卧位通气在新生儿急性呼吸窘迫综合征（NARDS）治疗中的应用效果。
方法回顾性选取46例NARDS患儿作为研究对象，将采用俯卧位通气治疗（俯卧位为主，交替侧卧位）的20例患儿纳入俯卧位组，将采用常规仰卧位通气治疗的26例患儿纳入仰卧位组。比较2组患儿机械通气治疗开始时和机械通气治疗4、24、48、72 h后的动脉血氧分压[pa（O2）]与吸入氧分数（FiO2）比值（P/F）、氧合指数（OI），观察2组治疗过程中肺表面活性物质（PS）使用次数和机械通气时间、总用氧时间、住院时间，并比较2组患儿治疗过程中相关并发症发生率、病死率等。
结果机械通气治疗4、24、48、72 h后，俯卧位组患儿pa（O2）、P/F均高于仰卧位组，OI值低于仰卧位组，差异有统计学意义（P < 0.05）；机械通气治疗72 h后，俯卧位组患儿动脉血二氧化碳分压[pa（CO2）]低于仰卧位组，差异有统计学意义（P < 0.05）。俯卧位组总用氧时间为（12.53±3.48）d，短于仰卧位组的（15.60±4.46）d，差异有统计学意义（P < 0.05）；2组PS使用次数、机械通气时间和住院时间比较，差异无统计学意义（P>0.05）；2组新生儿持续肺动脉高压发生率、病死率和并发症发生率比较，差异无统计学意义（P>0.05）。
结论俯卧位机械通气可有效改善NARDS患儿氧合功能及呼吸功能，缩短用氧时间，且不会增加相关并发症的发生。
-
关键词:
- 俯卧位通气 /
- 新生儿急性呼吸窘迫综合征 /
- 动脉血气分析 /
- 仰卧位通气 /
- 并发症
Abstract:ObjectiveTo observe application effect of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome (NARDS).
MethodsA total of 46 neonates with NARDS were retrospectively selected as study objects, among whom 20 cases with ventilation in prone position(mainly using prone position, and alternatively using lateral position) were included in prone position group, while 26 cases ventilated in conventional supine position were selected as supine position group. Arterial partial pressure of oxygen[pa(O2)] to inhaled oxygen fraction (FiO2) ratio (P/F) and oxygenation index of two groups of neonates at beginning of mechanical ventilation, and 4, 24, 48 and 72 h after mechanical ventilation were compared. The number of using pulmonary surfactant (PS) during treatment, mechanical ventilation time, total oxygen use time and length of hospital stay were observed, the incidence rates of related complications and the mortality during treatment were compared.
ResultsThe pa(O2) and P/F values of the neonates in the prone position group were higher than those of the supine position group, and the OI value was lower than that of the supine position group at 4, 24, 48 and 72 h after mechanical ventilation (P < 0.05); arterial partial pressure of carbon dioxide[pa(CO2)] after 72 h of mechanical ventilation was lower than that of the supine position group(P < 0.05). The total oxygen consumption time in the prone position group was shorter than that in the supine position group[(12.53±3.48) d versus (15.60±4.46) d, P < 0.05]. There were no significant differences in number of pulmonary surfactant usage, mechanical ventilation time and hospital stay (P>0.05). The incidence rates of neonatal persistent pulmonary hypertension, mortality, and complications between the two groups showed no significant differences(P>0.05).
ConclusionProne position mechanical ventilation can effectively improve the oxygenation and respiratory function of neonates with NARDS, shorten the time of oxygen use, and does not increase the occurrence of related complications.
-
-
表 1 2组患儿一般资料比较(±s)[M(P25, P75)][n(%)]
指标 分类 俯卧位组(n=20) 仰卧位组(n=26) χ2 P 性别 男 12(60.00) 15(57.69) 0.025 0.875 女 8(40.00) 11(42.31) 分娩方式 自然分娩 12(60.00) 17(65.38) 0.141 0.708 剖宫产 8(40.00) 9(34.62) 胎膜早破≥18 h 是 6(30.00) 8(30.77) 0.003 0.955 否 14(70.00) 18(69.23) 出生体质量/kg 2.81±0.69 2.92±0.73 -0.542 0.590 胎龄/周 36.50±2.62 37.04±3.18 -0.850 0.400 入院年龄/h 2.85(1.38, 7.55) 2.40(1.13, 4.25) -0.930 0.367 1 min Apgar评分/分 7.90±1.47 7.81±1.67 0.196 0.845 5 min Apgar评分/分 9.05±1.05 8.84±1.12 0.628 0.533 原发病因 肺出血 2(10.00) 2(7.69) < 0.001 1.000 感染 8(40.00) 9(34.62) 0.141 0.708 胎粪吸入综合征 4(20.00) 5(19.23) < 0.001 1.000 围生期窒息 2(10.00) 2(7.69) < 0.001 1.000 选择性剖宫产 2(10.00) 4(15.38) 0.009 0.924 其他 2(10.00) 4(15.38) 0.009 0.924 
下载: 导出CSV
表 2 2组患儿机械通气治疗不同时点血气指标水平比较(±s)[n(%)][M(P25, P75)]
组别 指标 机械通气治疗时点 治疗开始时 治疗4 h后 治疗24 h后 治疗48 h后 治疗72 h后 俯卧位组(n=20) pa(O2)/mmHg 45.70±6.90 59.20±7.80*# 61.30±8.32*# 68.80±5.88*# 72.80±9.18*# pa(CO2)/mmHg 53.05±7.02 49.85±7.06* 48.40±6.91* 47.70±5.81* 44.45±4.44*# (P/F)/mmHg 74.14±11.28 132.83±22.25*# 155.06±36.83*# 193.42±51.45*# 248.16±62.03*# OI 18.24(16.59, 21.35) 9.71(8.11, 10.75) *# 7.71(6.75, 9.20)*# 6.06(5.22, 7.26)*# 3.86(3.49, 5.05)*# 仰卧位组(n=26) pa(O2)/mmHg 45.35±7.28 53.04±8.88* 55.58±7.09* 62.04±6.86* 67.96±6.91* pa(CO2)/mmHg 52.38±5.86 51.38±7.45* 50.04±8.21* 48.81±5.60* 47.42±4.92* (P/F)/mmHg 80.43±19.16 110.69±30.36* 123.57±30.50* 159.47±54.41* 207.49±68.36* OI 16.33(14.27, 22.45) 11.91(9.65, 14.86)* 10.57(7.99, 13.28)* 7.50(5.69, 9.13)* 4.50(3.90, 7.21)* pa(O2): 动脉血氧分压; pa(CO2): 动脉血二氧化碳分压; P/F: 动脉血氧分压与吸入氧分数比值; OI: 氧合指数。与治疗开始时比较, *P < 0.05; 与仰卧位组比较, #P < 0.05。
下载: 导出CSV
表 3 2组患儿PS使用次数、机械通气时间、总用氧时间、住院时间和转归情况比较(±s)[n(%)]
组别 n PS使用次数/次 机械通气时间/d 总用氧时间/d 住院时间/d 发生PPHN 死亡 俯卧位组 20 1.20±0.62 6.78±2.37 12.53±3.48* 17.82±2.51 3(15.00) 3(15.00) 仰卧位组 26 1.23±0.51 8.22±2.82 15.60±4.46 18.86±4.25 5(19.23) 4(15.38) PS: 肺表面活性物质; PPHN: 新生儿持续肺动脉高压。与仰卧位组比较, *P < 0.05。
下载: 导出CSV
表 4 2组患儿治疗过程中并发症发生情况比较[n(%)]
组别 n 喂养不耐受 呼吸机相关性肺炎 气管插管移位 留置针移位 暂时性血氧饱和度下降 俯卧位组 20 4(20.00) 1(5.00) 5(25.00) 3(15.00) 3(15.00) 仰卧位组 26 2(7.69) 0 3(11.54) 2(7.69) 0
下载: 导出CSV
-
[1] 唐烁, 包蕾. 新生儿急性呼吸窘迫综合征临床特征与预后相关因素分析[J]. 第三军医大学学报, 2019, 41(9): 898-902. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201909014.htm [2] MARRARO G A, CHEN C, PIGA M A, 等. 儿童急性呼吸窘迫综合征的治疗进展[J]. 中国当代儿科杂志, 2014, 16(5): 437-447. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201405001.htm [3] DE LUCA D, VAN KAAM A H, TINGAY D G, et al. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity[J]. Lancet Respir Med, 2017, 5(8): 657-666. doi: 10.1016/S2213-2600(17)30214-X
[4] 中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 中国新生儿肺表面活性物质临床应用专家共识(2021版)[J]. 中华儿科杂志, 2021, 59(8): 627-632. doi: 10.3760/cma.j.cn112140-20210329-00261 [5] 中华医学会儿科学分会新生儿学组, 《中华儿科杂志》编辑委员会. 新生儿肺动脉高压诊治专家共识[J]. 中华儿科杂志, 2017, 55(3): 163-168. [6] CAREY W A, COLBY C E. Extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure[J]. Semin Cardiothorac Vasc Anesth, 2009, 13(3): 192-197. doi: 10.1177/1089253209347948
[7] 刘雪琴, 张卫星, 刘玉霞, 等. 俯卧位通气对新生儿呼吸机相关性肺炎的疗效[J]. 广东医学, 2015, 36(18): 2862-2864. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201518035.htm [8] 中华医学会重症医学分会重症呼吸学组. 急性呼吸窘迫综合征患者俯卧位通气治疗规范化流程[J]. 中华内科杂志, 2020, 59(10): 781-787. [9] 米洁, 黄桃, 高西. 俯卧位通气在急性呼吸窘迫综合征中的应用及护理干预研究[J]. 重庆医学, 2017, 46(14): 1904-1906. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201714011.htm [10] 徐军, 于学忠. ARDS与俯卧位通气[J]. 中国急救医学, 2004, 24(6): 430-432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJJY200406023.htm [11] RICHTER T, BELLANI G, SCOTT HARRIS R, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury[J]. Am J Respir Crit Care Med, 2005, 172(4): 480-487. doi: 10.1164/rccm.200501-004OC
[12] LUKS A M. Ventilatory strategies and supportive care in acute respiratory distress syndrome[J]. Influ Other Respir Viruses, 2013, 7(Suppl 3): 8-17.
[13] MACKENZIE C F. Anatomy, physiology, and pathology of the prone position and postural drainage[J]. Crit Care Med, 2001, 29(5): 1084-1085.
[14] 吕光宇, 蔡天斌, 蒋文芳, 等. VV-ECMO单用与联用俯卧位通气在急性呼吸窘迫综合征治疗中的疗效比较[J]. 中华危重病急救医学, 2021, 33(3): 293-298. [15] CURLEY M A Q, HIBBERD P L, FINEMAN L D, et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial[J]. JAMA, 2005, 294(2): 229-237.
[16] 雷光锋, 张雪晴, 张素霞. ALI/ARDS患者俯卧位与仰卧位通气的Meta分析[J]. 护理学杂志, 2016, 31(22): 87-92. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201622039.htm [17] SUD S, FRIEDRICH J O, ADHIKARI N K, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. CMAJ, 2014, 186(10): E381-E390.
-
期刊类型引用(4)
1. 张琼阁，徐燕，梁万强. CT血管造影三维重建技术对肺部占位性病变的定性诊断及敏感度、特异度、准确度评价. 辽宁医学杂志. 2024(05): 80-83 . 
百度学术
2. 粟华明，文鹏程. 胸部CT平扫、灌注成像对中央型肺癌诊断及分型的价值. 影像研究与医学应用. 2019(02): 199-200 . 百度学术
3. 沈玉美，章喜林，邢晓燕. 早期护理干预在预防老年非小细胞肺癌患者术后肺部感染及呼吸衰竭中的应用效果评价. 中国现代医生. 2019(22): 139-142 . 百度学术
4. 朱崇磊. 非小细胞肺癌组织的CT肺灌注成像及其与恶性分子表达量的相关性分析. 影像研究与医学应用. 2019(21): 89-90 . 百度学术
其他类型引用(0)
计量
- 文章访问数: 172
- HTML全文浏览量: 91
- PDF下载量: 11
- 被引次数: 4
苏公网安备 32100302010246号
