重症肺炎患儿机械通气治疗中呼气末二氧化碳分压监测的效果分析
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摘要
目的研究重症肺炎患儿机械通气治疗中持续监测呼气末二氧化碳分压(PETCO2)的临床价值及意义。方法选择2014年1月至2016年12月经我院诊断为重症肺炎并行机械通气的患儿38例。所有患儿均在5个同一时间点采用便携式血气分析仪进行血气分析,主要检测指标为动脉血气检测之下的二氧化碳分压(PaCO_2)以及PETCO_2。结果 38例患儿中,36例患儿PETCO2与PaCO_2呈正相关,且r均>0.75。对患儿进行进一步治疗,2项主要观察指标之间的平均偏差值指标差异明显减少。结论针对血流动力学相对稳定的患儿来说,PETCO_2与PaCO_2之间具有相对较好的相关性。P_(ET)CO_2能够更好的提升患者在血流、代谢以及通气等相关方面指标的检测,其操作简便、无创和连续等相关方面的优势,对机械通气的整体治疗效果提升具有积极意义,有较好的临床应用价值。
Objective To assess the clinical value and significance of continuous monitoring of the end-expiratory partial pressure of carbon dioxide in children with severe pneumonia during mechanical ventilation. Methods From January 2014 to December 2016,38 children diagnosed as severe pneumonia and requiring mechanical ventilation were enrolled in the study. All the children were analyzed by a portable blood gas analyzer at the same 5 time points. The partial pressure of carbon dioxide(PaCO2)(arterial blood gas monitoring) and partial pressure of carbon dioxide(PETCO2) at the end of expiration were noted. Results A significant positive correlation between PETCO2 and PaCO2 and an r value > 0.75 was noted in 36/38 children. With further treatment,the difference of average deviation between PaCO2 and PETCO2 was significantly reduced. Conclusion For children with relatively stable hemodynamics,there is a relatively good correlation between PETCO2 and PaCO2. PETCO2 can improve the detection of blood flow,metabolism,ventilation,and other related parameters in patients. Moreover,it is simple to estimate,non-invasive,and continuous. It has positive significance and good clinical application value for the improvement of the overall therapeutic effect of mechanical ventilation.
Objective To assess the clinical value and significance of continuous monitoring of the end-expiratory partial pressure of carbon dioxide in children with severe pneumonia during mechanical ventilation. Methods From January 2014 to December 2016,38 children diagnosed as severe pneumonia and requiring mechanical ventilation were enrolled in the study. All the children were analyzed by a portable blood gas analyzer at the same 5 time points. The partial pressure of carbon dioxide(PaCO2)(arterial blood gas monitoring) and partial pressure of carbon dioxide(PETCO2) at the end of expiration were noted. Results A significant positive correlation between PETCO2 and PaCO2 and an r value > 0.75 was noted in 36/38 children. With further treatment,the difference of average deviation between PaCO2 and PETCO2 was significantly reduced. Conclusion For children with relatively stable hemodynamics,there is a relatively good correlation between PETCO2 and PaCO2. PETCO2 can improve the detection of blood flow,metabolism,ventilation,and other related parameters in patients. Moreover,it is simple to estimate,non-invasive,and continuous. It has positive significance and good clinical application value for the improvement of the overall therapeutic effect of mechanical ventilation.
引文
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[11]林轶群,陆国平,林岚岚.2010年儿童心肺复苏及生命支持指南解读[J].中国小儿急救,2011,18(1):22.DOI:10.3760/cma.j.issn.1673-4912.2011.01.008.
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[2]IGOR R,CYNTHIA BP,ZRINKA B,et al.Epidemiology and etiology of childhood pneumonia[J].Bull World Health Organ,2008,86(5):408-416.DOI:10.2417-BLT.07048769.
[3]许峰.小儿机械通气的基本步骤[J].中国实用儿科杂志,2010,25(2):94-95.DOI:1005-2224(2010)02-0094-04.
[4]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1176-1178.
[5]陈爱斌.婴幼儿重症肺炎死亡高危因素分析[J].实用全科医学,2005,3(5):437-439.
[6]赵祖星.营养泵对重症肺炎机械通气患者免疫功能的影响[J].海南医学院学报,2012,18(9):1263-1265.DOI:1007-1237(2012)09-1263-03.
[7]骆丽慧,谭玲.小儿喉罩拔除时机与呼气末二氧化碳分压的相关性[J].实用医学杂志,2012,28(3):429-431.DOI:10.3969/j.issn.1006-5725.2012.03.032.
[8]喻文亮,钱素云,陶建平.小儿机械通气[M].上海:上海科学技术出版社,2012:318-320.
[9]刘春峰,不同疾病状态下机械通气策略和参数调节[J].中国小儿急救医学杂志,2010,17(3):193.DOI:10.3760-cma.j.issn.1673-4912.2010.0300I.
[10]孙波.常规机械通气及儿科临床应用[J].中国当代儿科杂志,2001,3(6):620.DOI:10.3969/j.issn.1008-8830.2001.06.002.
[11]林轶群,陆国平,林岚岚.2010年儿童心肺复苏及生命支持指南解读[J].中国小儿急救,2011,18(1):22.DOI:10.3760/cma.j.issn.1673-4912.2011.01.008.
[12]赵静静,马青变.呼气末二氧化碳检测在心肺复苏中的应用进展[J].中国急救医学,2011,31(4):358-360.DOI:10.3969/j.issn.1002-1949.2011.04.019.