高频通气联合抗生素阶梯疗法对小儿重症肺炎肺泡—动脉氧分压差的影响(1)
[摘要] 目的 探讨高频通气联合抗生素阶梯疗法对小儿重症肺炎肺泡-动脉氧分压差(A-aDO2)的影响。 方法 选择2013年3月～2015年12月邢台市第三医院医治的92例重症肺炎患儿为研究对象，采用随机数字表法将患儿分为试验组和对照组，每组各46例。试验组行高频通气联合抗生素阶梯疗法治疗，对照组行普通机械通气联合常规抗生素治疗；观察两组患儿治疗前及治疗后3、7 d肺泡-动脉氧分压差(A-aDO2)，动脉血氧分压(PaO2)，二氧化碳分压(PaCO2)，氧浓度(FiO2)，及动脉血氧饱和度(SaO2)等变化情况，并对治疗效果、死亡率、ICU住院时间、机械通气时间、再上机率等指标进行分析。 结果 试验组总有效率91.3%显著高于对照组71.72%(P < 0.01)；试验组患儿再上机率、死亡率、ICU住院时间、机械通气时间均显著低于对照组(P < 0.01)；治疗后3、7 d两组患儿PaO2及SaO2均较治疗前显著提高，FiO2、A-aDO2、PaCO2均较治疗前显著下降(P < 0.01)；治疗后各时间点试验组肺功能各指标改善情况均显著优于对照组(P < 0.01)。 结论 高频通气联合抗生素阶梯疗法治疗小儿重症肺炎，在降低患儿A-aDO2、改善肺功能、降低死亡率，及提高总体疗效方面效果均非常显著，值得推广使用。
[关键词] 高频通气；抗生素阶梯疗法；小儿重症肺炎；肺泡-动脉氧分压差
[中图分类号] R572 [文献标识码] A [文章编号] 1673-7210(2016)05(b)-0080-04
[Abstract] Objective To explore the effects of high-frequency ventilation combined with de-escalation antibiotics therapy on alveolar-arterial oxygen partial pressure difference in children with severe pneumonia. Methods 92 cases of children with severe pneumonia treated in the Third Hospital of Xingtai City from March 2013 to December 2015 were selected as the research subjects， who were divided into experimental group and control group according to the random digital table method， 46 cases in each group. The experimental group was given high-frequency ventilation combined with de-escalation antibiotics therapy for treatment， and the control group was given general mechanical ventilation combined with conventional antibiotic therapy for treatment. The changes of A-aDO2， arterial partial pressure of oxygen (PaO2)， carbon dioxide partial pressure (PaCO2)， oxygen concentration (FiO2) and arterial oxygen saturation (SaO2) of the two groups before treatme， 3 d and 7 d after treatment were observed， and the indexes such as treatment effects， mortality， length of stay in ICU， average mechanical ventilation time， and the rates of re-machine were analyzed. Results The total effective rate in the experimental group was 91.3%， significantly higher than that of the control group (71.72%) (P < 0.01)， and the mortality rate was 6.52%， significantly lower than that of the control group (23.91%) (P < 0.01). The rate of re-machine， mortality， length of stay in ICU and ventilation time in the experimental group were significantly lower than those in the control group (P < 0.01). The PaO2 and SaO2 3 d and 7 d after treatment were significantly increased compared with those before treatment， and the A-aDO2， PaCO2 and FiO2 were significantly decreased compared with those before treatment (P < 0.01). The improvement of PaO2， SaO2 and A-aDO2， PaCO2， FiO2 levels in the experimental group were significantly better than those in the control group at each time after treatment (P < 0.01). Conclusion The effects of high-frequency ventilation combined with de-escalation antibiotics therapy on reducing the A-aDO2 level， improving lung function， reducing mortality rate，and improving the total effects were remarkable， which is worthy of promotion and application. (郭义军 郝现伟 张丽 李小亮)
[关键词] 高频通气；抗生素阶梯疗法；小儿重症肺炎；肺泡-动脉氧分压差
[中图分类号] R572 [文献标识码] A [文章编号] 1673-7210(2016)05(b)-0080-04
[Abstract] Objective To explore the effects of high-frequency ventilation combined with de-escalation antibiotics therapy on alveolar-arterial oxygen partial pressure difference in children with severe pneumonia. Methods 92 cases of children with severe pneumonia treated in the Third Hospital of Xingtai City from March 2013 to December 2015 were selected as the research subjects， who were divided into experimental group and control group according to the random digital table method， 46 cases in each group. The experimental group was given high-frequency ventilation combined with de-escalation antibiotics therapy for treatment， and the control group was given general mechanical ventilation combined with conventional antibiotic therapy for treatment. The changes of A-aDO2， arterial partial pressure of oxygen (PaO2)， carbon dioxide partial pressure (PaCO2)， oxygen concentration (FiO2) and arterial oxygen saturation (SaO2) of the two groups before treatme， 3 d and 7 d after treatment were observed， and the indexes such as treatment effects， mortality， length of stay in ICU， average mechanical ventilation time， and the rates of re-machine were analyzed. Results The total effective rate in the experimental group was 91.3%， significantly higher than that of the control group (71.72%) (P < 0.01)， and the mortality rate was 6.52%， significantly lower than that of the control group (23.91%) (P < 0.01). The rate of re-machine， mortality， length of stay in ICU and ventilation time in the experimental group were significantly lower than those in the control group (P < 0.01). The PaO2 and SaO2 3 d and 7 d after treatment were significantly increased compared with those before treatment， and the A-aDO2， PaCO2 and FiO2 were significantly decreased compared with those before treatment (P < 0.01). The improvement of PaO2， SaO2 and A-aDO2， PaCO2， FiO2 levels in the experimental group were significantly better than those in the control group at each time after treatment (P < 0.01). Conclusion The effects of high-frequency ventilation combined with de-escalation antibiotics therapy on reducing the A-aDO2 level， improving lung function， reducing mortality rate，and improving the total effects were remarkable， which is worthy of promotion and application. (郭义军 郝现伟 张丽 李小亮)