气道闭合压呼出气末二氧化碳在小儿非肺源性呼吸衰竭机械通气中的应用

Clinical values of P0.1 and PetCO2 in pediatric patients with mechanical ventilation

摘要:

目的：气道闭合压(P0.1)、呼出气末二氧化碳(PetCO2)在小儿非肺源性呼吸衰竭机械通气中的临床价值研究报道甚少。为此,该研究在这方面做一探讨。方法：对于收住儿童ICU的呼吸衰竭机械通气的患儿,监测P0.1,PetCO2。结果：P0.1在成功撤机时与上呼吸机第1天比较差异均有显著性,各年龄组0岁～,1岁～,3～16岁数据依次如下:1.8±0.25cmH2O,2.0±0.27cmH2O,2.1±0.28cmH2O。呼出气末二氧化碳(PetCO2)与动脉血二氧化碳(PaCO2)有显著正相关(r=0.894,P<0.001)。结论：在机械通气中,通过检测P0.1,PetCO2的动态变化,可了解患者的病情变化,指导呼吸机参数的调节;为临床小儿呼吸机的成功撤离提供了有关肺功能的预测指标。

Abstract:

OBJECTIVE: Airway occlusion pressure at 0.1 sec (P_ 0.1) has been widely used in the assessment of respiratory function. This study aimed to assess the values of P_ 0.1 and end-expiratory CO_2 (PetCO_2) in pediatric patients with mechanical ventilation. METHODS: A total of 29 mechanical-ventilation children, aged ranging from 8 months to 16 years(average of 4.3 years), with non-pulmonary respiratory failure admitted to the intensive care unit were included in this study. P_ 0.1 and PetCO_2 were monitored during mechanical ventilation. RESULTS: P_ 0.1 obtained on the day of weaning from the respirator increased significantly compared with that on the first day in the 0- 1 years old group (1.8±0.25 cmH_2O vs 0.23±0.17 cmH_2O),the 1- 3 years old group (2.0±0.27 cmH_2O vs 0.13±0.10 cmH_2O ) and the 3-16 years old group ( 2.1±0.28 cmH_2O vs 0.30±0.17 cmH_2O) (P< 0.001). PetCO_2 positively correlated with PaCO_2 (r= 0.894, P< 0.001). CONCLUSIONS: Monitoring the changes of P_ 0.1 and PetCO_2 is useful in adjusting the parameters of the respirator during mechanical ventilation. P_ 0.1 may serve as a marker for weaning from mechanical ventilation.