作者：金建国，华晴

单位：

433000湖北省仙桃市，长江大学附属仙桃市第一人民医院儿科

Units：

Department of Pediatrics, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao 433000, China

关键词：

肺炎；呼吸衰竭；儿童；双相气道正压通气；同步间歇指令通气；治疗结果

Keywords：

Pneumonia; Respiratory failure; Child; Biphasic positive airway pressure; Synchronized intermittent mandatory ventilation; Treatment outcome

CLC：

R 563.1 R 563.8

DOI：

10.12114/j.issn.1008-5971.2023.00.304

Funds：

湖北省自然科学基金资助项目（2019CFB317）

摘要：

目的　比较双相气道正压通气（BIPAP）与同步间歇指令通气（SIMV）治疗急性重症肺炎伴呼吸衰 竭患儿的临床疗效。方法　选取2019年8月至2021年8月长江大学附属仙桃市第一人民医院收治的 92例急性重症肺炎 伴呼吸衰竭患儿，根据治疗方法不同将其分为BIPAP组（ n=44）和SIMV组（n=48）。比较两组患儿临床疗效，治疗 前后氧合功能指标〔PaO2、PaCO2、氧合指数（OI）〕和呼吸力学指标（气道峰压、平台压和气道阻力），气促持续 时间、发绀持续时间、住院时间及并发症发生率。结果　SIMV组临床疗效优于BIPAP组（P＜0.05）。治疗后，两组 PaO2、OI分别高于本组治疗前，PaCO2分别低于本组治疗前，且SIMV组PaO2、OI高于BIPAP组，PaCO2低于BIPAP组 （P＜0.05）。治疗后，两组气道峰压、平台压、气道阻力分别低于本组治疗前，且SIMV组气道峰压、平台压、气 道阻力低于BIPAP组（P＜0.05）。SIMV组气促持续时间、发绀持续时间和住院时间均短于BIPAP组（P＜0.05 ）。治 疗期间，SIMV组并发症发生率为2.1%（1/48），与BIPAP组的6.8%（3/44）比较，差异无统计学意义（χ 2 =0.361 ， P=0.548）。结论　与BIPAP相比，SIMV能提高急性重症肺炎伴呼吸衰竭患儿的临床疗效，改善其氧合功能和呼吸力 学指标，缩短其临床症状缓解时间及住院时间，且安全性较高。

Abstract：

Objective To compare the clinical efficacy of biphasic positive airway pressure (BIPAP) and synchronized intermittent mandatory ventilation (SIMV) in the treatment of children with acute severe pneumonia and respiratory failure. Methods A total of 92 children with acute severe pneumonia and respiratory failure admitted to Xiantao First People's Hospital Affiliated to Yangtze University from August 2019 to August 2021 were selected and divided into BIPAP group (n=44) and SIMV group (n=48) based on different treatment methods. The clinical efficacy, oxygenation function indexes [PaO2, PaCO2, oxygenation index (OI) ] and respiratory mechanics indexes (peak airway pressure, plateau pressure and airway resistance) before and after treatment, duration of shortness of breath, duration of cyanosis, hospitalization time, and incidence of complications were compared between the two groups. Results The clinical efficacy of the SIMV group was better than that of the BIPAP group (P < 0.05) . After treatment, PaO2 and OI in both groups were higher than those before treatment, PaCO2 was lower than that before treatment, respectively, and PaO2 and OI in the SIMV group were higher than those in the BIPAP group, while PaCO2 was lower than that in the BIPAP group (P < 0.05) . After treatment, the peak airway pressure, plateau pressure, and airway resistance in both groups were lower than those before treatment respectively, and the peak airway pressure, plateau pressure, and airway resistance in the SIMV group were lower than those in the BIPAP group (P < 0.05) . The duration of shortness of breath, duration of cyanosis, hospitalization time in the SIMV group were shorter than those in the BIPAP group (P < 0.05) . During the treatment period, there was no significant difference in incidence of complications between SIMV group and BIPAP group [2.1 % (1/48) vs 6.8% (3/44) , χ 2 =0.361, P=0.548] . Conclusion Compared with BIPAP, SIMV can improve the clinical efficacy in children with acute severe pneumonia and respiratory failure, improve oxygenation function and respiratory mechanics indexes, shorten clinical symptom relief time and hospitalization time, and has higher safety.

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