俯卧位通气对新生儿呼吸机相关性肺炎的疗效
摘要
目的探讨新生儿呼吸机相关性肺炎(VAP)患儿采用俯卧位通气(PPV)治疗的临床效果。方法60例发生VAP的新生儿随机分成观察组和对照组,观察组30例在氧疗时采用PPV,每4 h 1次,每次治疗1 h;对照组30例使用仰卧位通气。治疗前和治疗后1 h,两组患儿各做血气分析,记录Pa O2、Pa CO2、Pa O2/Fi O2、Aa DO2、Pa O2/PAO2、RR,观察相同时间患儿的氧合状态及Pa CO2、RR的变化。于治疗后第1、5天,观察两组患儿PCT、简易CPIS评分,评估新生儿VAP的治疗效果。结果观察组氧合功能明显优于对照组,差异有统计学意义;观察组与对照组患儿Pa CO2、RR变化无统计学意义。治疗5 d时观察组PCT下降程度较对照组快,差异有统计学意义;治疗5 d时,观察组简易CPIS评分明显低于对照组,差异有统计学意义。结论新生儿VAP采用PPV能改善氧合功能,较仰卧位能更快减轻VAP感染的严重程度。
引文
[1]PIEHL M A,BROWN B S.Use of extreme position changes in actlte respiratory failure[J].Crit Care Med,1976,4(1):13-14.
[2]MARTIN R J,HERREL N,RUBIN D,et al.Effect of supine position on arterial oxygen tension in the preterm infant[J].Pediatrics,1979,63(4):528-531.
[3]CHAISUPAMONGKOLLARP T,PREUTHIPAN A,VAICHEETA S,et al.Prone position in spontaneously breathing infants with pneumonia[J].Acta Paediatr,1999,88(9):1033-1034.
[4]ROMERO C M,CORNEJO R A,GALVEZ L R,et al.Extended prone position ventilation in severe acute respiratory distress syndrome:a pilot feasibility study[J].J Crit Care,2009,24(1):81-88.
[5]薛辛东,王晓惠,张家骧.仰俯卧位对早产儿肺功能的影响[J].中华儿科杂志,1999,26(8):494-496.
[6]邵肖梅,叶鸿瑁,邱小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2012:405.
[7]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[8]李海霞,张卫星,刘芳,等.新生儿呼吸窘迫综合征患儿在呼吸机辅助呼吸下采用俯卧位通气的效果评价[J].中国医药指南,2014,5(10):169-170.
[9]叶俊,修清玉.机械通气相关肺炎发病机理及预防研究进展[J].中华医学杂志,2006,86(41):2950-2952.
[10]SAIMAN L,LUDINGTON E,DOESON J D,et al.Risk factors for Candida species colonization of neonatal intensive care unit patients[J].Pediatr Infect Dis J,2001,20(12):1119-1124.
[11]LUNA C M,BLANZACO D,NIEDERMEN M S,et al.Resolution of ventilator-associated pneumonia:prospective enaluation of the clinical pulmonary infection score as an early clinical predictor of outcome[J].Crit Care Med,2003,31(3):676-682.
[12]RAMIREZ P,GARCIA M A,FERRER M,et al.Sequential measurements of procalcitonin lerels in diagnosing ventilator-associated pneumonia[J].Eur Respir J,2008,31(2):356-362.
[13]JEFFERY H E,MEGEVAND A,PAGE H D.Why the prone position is a riak ractor for sudden infant death syndrome[J].Pediatrics,1999,104(2 Pt 1):263-269.
[2]MARTIN R J,HERREL N,RUBIN D,et al.Effect of supine position on arterial oxygen tension in the preterm infant[J].Pediatrics,1979,63(4):528-531.
[3]CHAISUPAMONGKOLLARP T,PREUTHIPAN A,VAICHEETA S,et al.Prone position in spontaneously breathing infants with pneumonia[J].Acta Paediatr,1999,88(9):1033-1034.
[4]ROMERO C M,CORNEJO R A,GALVEZ L R,et al.Extended prone position ventilation in severe acute respiratory distress syndrome:a pilot feasibility study[J].J Crit Care,2009,24(1):81-88.
[5]薛辛东,王晓惠,张家骧.仰俯卧位对早产儿肺功能的影响[J].中华儿科杂志,1999,26(8):494-496.
[6]邵肖梅,叶鸿瑁,邱小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2012:405.
[7]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[8]李海霞,张卫星,刘芳,等.新生儿呼吸窘迫综合征患儿在呼吸机辅助呼吸下采用俯卧位通气的效果评价[J].中国医药指南,2014,5(10):169-170.
[9]叶俊,修清玉.机械通气相关肺炎发病机理及预防研究进展[J].中华医学杂志,2006,86(41):2950-2952.
[10]SAIMAN L,LUDINGTON E,DOESON J D,et al.Risk factors for Candida species colonization of neonatal intensive care unit patients[J].Pediatr Infect Dis J,2001,20(12):1119-1124.
[11]LUNA C M,BLANZACO D,NIEDERMEN M S,et al.Resolution of ventilator-associated pneumonia:prospective enaluation of the clinical pulmonary infection score as an early clinical predictor of outcome[J].Crit Care Med,2003,31(3):676-682.
[12]RAMIREZ P,GARCIA M A,FERRER M,et al.Sequential measurements of procalcitonin lerels in diagnosing ventilator-associated pneumonia[J].Eur Respir J,2008,31(2):356-362.
[13]JEFFERY H E,MEGEVAND A,PAGE H D.Why the prone position is a riak ractor for sudden infant death syndrome[J].Pediatrics,1999,104(2 Pt 1):263-269.