不同潮气量通气对重症肺炎患儿呼吸力学和血流动力学的影响

doi:10.11958/20250327

天津医药 ›› 2025, Vol. 53 ›› Issue (7): 747-750.doi: 10.11958/20250327

不同潮气量通气对重症肺炎患儿呼吸力学和血流动力学的影响

吴小霞¹(), 郭建新¹, 瞿梦婷¹, 娜迪热·海如拉¹, 扎依旦·艾力¹, 程永凤²^,^△()

1 新疆医科大学第一附属医院小儿急危重症医学科（邮编830054）
2 新疆医科大学第一附属医院儿内一科（邮编830054）

收稿日期:2025-01-20 修回日期:2025-04-29 出版日期:2025-07-15 发布日期:2025-07-21
通讯作者: ^△E-mail：1456301676@qq.com
作者简介:吴小霞（1991），女，医师，主要从事儿童急危重症方面研究。E-mail：xjpcf123@163.com
基金资助:
新疆维吾尔自治区科技技术项目基金(2022D01C739)

Study on the effects of different tidal volume ventilation on respiratory mechanics and hemodynamics in children with severe pneumonia

WU Xiaoxia¹(), GUO Jianxin¹, QU Mengting¹, NADIR Hairula¹, ZHAYIDAN Aili¹, CHENG Yongfeng²^,^△()

1 Department of Pediatric Emergency and Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
2 Department of Pediatric, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China

Received:2025-01-20 Revised:2025-04-29 Published:2025-07-15 Online:2025-07-21
Contact: ^△E-mail：1456301676@qq.com

吴小霞, 郭建新, 瞿梦婷, 娜迪热·海如拉, 扎依旦·艾力, 程永凤. 不同潮气量通气对重症肺炎患儿呼吸力学和血流动力学的影响[J]. 天津医药, 2025, 53(7): 747-750.

WU Xiaoxia, GUO Jianxin, QU Mengting, NADIR Hairula, ZHAYIDAN Aili, CHENG Yongfeng. Study on the effects of different tidal volume ventilation on respiratory mechanics and hemodynamics in children with severe pneumonia[J]. Tianjin Medical Journal, 2025, 53(7): 747-750.

摘要/Abstract

摘要：

目的探究不同潮气量通气对重症肺炎患儿呼吸力学和血流动力学的影响。方法 104例重症肺炎患儿按照随机数字表法分为对照组与观察组，各52例。2组均行机械通气治疗，对照组采用常规潮气量（10~12 mL/kg），观察组采用小潮气量（6~8 mL/kg），对比2组患儿治疗前后的呼吸力学指标、血流动力学指标和炎性因子指标。结果治疗后，观察组的气道阻力（AR）、气道闭合压（AOP）低于对照组，肺动态顺应性（Cdyn）高于对照组（P<0.05），2组治疗后的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）差异均无统计学意义（P>0.05），观察组血清白细胞介素（IL）-6、IL-8、肿瘤坏死因子-α（TNF-α）均低于对照组（P<0.05）。结论小潮气量机械通气可有效改善重症肺炎患儿的呼吸力学，且不会使其血流动力学产生大幅度波动，同时还能减轻机体的炎性因子水平。

关键词: 潮气量, 呼吸, 人工, 呼吸力学, 血流动力学, 重症肺炎

Abstract:

Objective To investigate the effect of ventilation with different tidal volumes on respiratory mechanics and haemodynamics in children with severe pneumonia. Methods A total of 104 children with severe pneumonia were divided into the control group and the observation group using a random number table method, with 52 cases in each group. Both groups underwent mechanical ventilation treatment. The control group was treated with conventional tidal volume of 10-12 mL/kg, while the observation group was given a low tidal volume of 6-8 mL/kg. The respiratory mechanics indicators, hemodynamic indicators and inflammatory factor indicators before and after treatment were compared between the two groups. Results After treatment, the airway resistance (AR) and airway closing pressure (AOP) were lower in the observation group than those of the control group (P<0.05), and pulmonary dynamic compliance (Cdyn) was higher in the observation group than that of the control group (P<0.05). There were no significant differences in heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) after treatment between the two groups (P<0.05). After treatment, the levels of interleukin (IL）-6, IL-8 and tumor necrosis factor-α (TNF-α) were all lower in the observation group than those in the control group (P<0.05). Conclusion Small tidal volume mechanical ventilation is effective in improving the respiratory mechanics of children with severe pneumonia without causing large fluctuations in their hemodynamics. At the same time, it can reduce the level of inflammatory factors in the organism.

Key words: tidal volume, respiration, artificial, respiratory mechanics, hemodynamics, severe pneumonia

中图分类号:

R725.6

图/表 4

参考文献 20

[1]	熊永辉, 李修平, 胡晓蓉, 等. 氧气驱动雾化吸入联合有创机械通气对重症肺炎并发呼吸衰竭患者痰液黏稠度、炎症指标的影响[J]. 中国基层医药, 2024, 31(7):976-981.
	XIONG Y H, LI X P, HU X R, et al. Effect of oxygen-driven nebulization inhalation combined with invasive mechanical ventilation on sputum viscosity and inflammatory indices in patients with severe pneumonia complicated by respiratory failure[J]. Chin J Prim Med Pharm, 2024, 31(7):976-981. doi:10.3760/cma.j.cn341190-20231009-00267.
[2]	HATAKEYAMA J, NAKAMURA K, INOUE S, et al. Two-year trajectory of functional recovery and quality of life in post-intensive care syndrome:a multicenter prospective observational study on mechanically ventilated patients with coronavirus disease-19[J]. J Intensive Care, 2025, 13(1):7. doi:10.1186/s40560-025-00777-z.
[3]	石燕华, 陈赫赫. 小潮气量联合抗生素阶梯疗法治疗小儿重症肺炎的效果[J]. 中国妇幼保健, 2021, 36(6):1305-1308.
	SHI Y H, CHEN H H. Effect of low tidal volume combined with antibiotic staggered therapy on severe pneumonia in children[J]. Maternal and Child Health Care of China, 2021, 36(6):1305-1308. doi:10.19829/j.zgfybj.issn.1001-4411.2021.06.029
[4]	江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京: 人民卫生出版社,2015:1258-1259.
	JIANG Z F, SHEN K L, SHEN Y. ZHU F T’s Practical Pediatrics[M]. 8th ed. Beijing: People’s Medical Publishing House,2015:1258-1259.
[5]	孙治霞, 王丽辉, 索红亮, 等. 加味桃仁承气汤对机械通气相关性肺损伤大鼠细胞自噬的影响[J]. 天津医药, 2023, 51(12):1349-1355.
	SUN Z X, WANG L H, SUO H L, et al. Effect of Jiawei Taoren Chengqi Decoction on autophagy in rats with mechanical ventilation-induced lung injury[J]. Tianjin Med J, 2023, 51(12):1349-1355. doi:10.11958/20230374.
[6]	WU W, WEI S, XUE C X, et al. An IncN-ST7 epidemic plasmid mediates the dissemination of carbapenem-resistant Klebsiella pneumoniae in a neonatal intensive care unit over 10 years,China[J]. Int J Antimicrob Agents, 2023, 62(3):106921-106928. doi:10.1016/j.ijantimicag.
[7]	MINESHITA M, NISHINE H, HANDA H, et al. 90-day outcomes in patients with severe COVID-19 pneumonia treated with invasive mechanical ventilation[J]. J Infect Chemother, 2025, 31(2):102529. doi:10.1016/j.jiac.2024.09.018.
[8]	KILINC M T, OZKENT M S, CAVDAR O F, et al. Does tidal volume during mechanical ventilation affect pediatric retrograde intrarenal surgery outcomes?[J]. World J Urol, 2025, 43(1):103. doi:10.1007/s00345-025-05480-0.
[9]	颜瑶, 谢永鹏, 杜志强, 等. 动态肺顺应性标化的机械功与机械通气患者撤机结局及预后的相关性分析:一项前瞻性观察性队列研究[J]. 中华危重病急救医学, 2025, 37(1):36-42.
	YAN Y, XIE Y P, DU Z Q, et al. Correlation analysis between mechanical power normalized to dynamic lung compliance and weaning outcomes and prognosis in mechanically ventilated patients:a prospective,observational cohort study[J]. Chin Crit Care Med, 2025, 37(1):36-42. doi:10.3760/cma.j.cn121430-20240126-00085.
[10]	陈博文. 哌拉西林钠舒巴坦钠联合吸入用乙酰半胱氨酸对重症肺炎患者血气指标及呼吸力学参数的影响[J]. 中国医学创新, 2025, 22(3):43-47.
	CHEN B W. Effects of piperacillin sodium and sulbactam sodium combined with acetylcysteine for inhalation on blood gas indexes and breathing mechanics parameters in patients with severe pneumonia[J]. Medical Innovation of China, 2025, 22(3):43-47. doi:10.3969/j.issn.1674-4985.2025.03.011.
[11]	王奇坤, 宫晓丽. 俯卧位通气治疗小儿肺炎合并呼吸衰竭的临床效果、安全性及对肺动态顺应性的影响分析[J]. 中国现代药物应用, 2024, 18(12):46-49.
	WANG Q K, GONG X L. Analysis of the clinical efficacy,safety of prone position ventilation in the treatment of children with pneumonia and respiratory failure and its influence on dynamic pulmonary compliance[J]. Chinese Journal of Modern Drug Application, 2024, 18(12):46-49. doi:10.14164/j.cnki.cn11-5581/r.2024.12.011.
[12]	DUPONT J, ROMAN DURA B, SALCICCIA A, et al. Retrospective study of the changes in dynamic compliance and ventilation/perfusion mismatch following salbutamol inhalation in hypoxaemic mechanically ventilated anaesthetized horses[J]. Vet Anaesth Analg, 2024, 51(5):465-474. doi:10.1016/j.vaa.2024.06.008.
[13]	TANIOS M, WU T T, NGUYEN H M, et al. Comparing the impact of targeting limited driving pressure to low tidal volume ventilation on mortality in mechanically ventilated adults with COVID-19 ARDS:an exploratory target trial emulation[J]. BMJ Open Respir Res, 2024, 11(1):e002439. doi:10.1136/bmjresp-2024-002439.
[14]	申志刚, 刘燕舞, 刘仁英, 等. 小潮气量通气对微创肝手术患者动脉血气参数、心脏功能的影响[J]. 中国现代普通外科进展, 2022, 25(8):657-659.
	SHEN Z G, LIU Y W, LIU R Y, et al. The impact of low tidal volume ventilation on arterial blood gas parameters and cardiac function in patients undergoing minimally invasive liver surgery[J]. Prog Gen Surg in China, 2022, 25(8):657-659. doi:10.3969/j.issn.1009-9905.2022.08.017.
[15]	刘军, 张辉, 石颖, 等. 不同潮气量机械通气对急性呼吸窘迫综合征大鼠右心血流动力学的影响[J]. 中华危重病急救医学, 2021, 33(1):49-52.
	LIU J, ZHANG H, SHI Y, et al. Effects of mechanical ventilation with different tidal volumes on right ventricular hemodynamics in acute respiratory distress syndrome rats[J]. Chinese Critical Care Medicine, 2021, 33(1):49-52. doi:10.3760/cma.j.cn121430-20200710-00513.
[16]	张军红, 刘雪芹, 孙国玉. 不同潮气量机械通气治疗重症肺炎患儿的有效性和安全性[J]. 中国妇幼保健, 2022, 37(2):249-251.
	ZHANG J H, LIU X Q, SUN G Y. Efficacy and safety of different tidal volumes of mechanical ventilation in the treatment of children with severe pneumonia[J]. Maternal and Child Health Care of China, 2022, 37(2):249-251. doi:10.19829/j.zgfybj.issn.1001-4411.2022.02.018.
[17]	汤荣宁, 张晶晶. 不同潮气量机械通气对小儿重症肺炎血气指标、炎症因子及肺泡灌洗液相关指标水平的影响[J]. 微创医学, 2022, 17(1):99-102.
	TANG R N, ZHANG J J. The impact of different tidal volumes of mechanical ventilation on blood gas indicators,inflammatory factors,and levels of related indices in alveolar lavage fluid in children with severe pneumonia[J]. MIM, 2022, 17(1):99-102. doi:10.11864/j.issn.1673.2022.01.25.
[18]	WU Z, CHU C, YING D, et al. Clinical significance of serum microRNA-146a and inflammatory factors in children with Mycoplasma pneumoniae pneumonia after azithromycin treatment.[J]. J Pediatr (Rio J), 2023, 100(1):108-115.doi:10.1016/j.jped.2023.06.004.
[19]	YU W, YI Y, WANG DM, et al. Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia[J]. World J Clin Cases, 2022, 10 (33):12146-12155. doi:10.12998/wjcc.v10.i33.12146.
[20]	DONATI P A, TARRAGONA L, ARAOS J, et al. Tidal volume selection in volume-controlled ventilation guided by driving pressure versus actual body weight in healthy anesthetized and mechanically ventilated dogs:A randomized crossover trial[J]. Vet Anaesth Analg, 2024, 51(5):408-416. doi:10.1016/j.vaa.2024.05.006.

组别	n	性别（男/女）	年龄/岁	体质量/kg	病程/d
对照组	52	28/24	3.89±0.74	10.13±2.30	10.21±1.57
观察组	52	29/23	4.02±0.81	10.84±2.63	10.43±1.42
χ²或t		0.039	0.854	1.465	0.749

组别	n	性别（男/女）	年龄/岁	体质量/kg	病程/d
对照组	52	28/24	3.89±0.74	10.13±2.30	10.21±1.57
观察组	52	29/23	4.02±0.81	10.84±2.63	10.43±1.42
χ²或t		0.039	0.854	1.465	0.749

组别	AR/[cmH₂O/（L·s）]			AOP/（cmH₂O）			Cdyn/（mL/cmH₂O）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	95.76±7.46	42.97±8.46	37.173^＊＊	2.00±0.54	3.85±0.52	18.496^＊＊	2.51±0.42	4.93±0.51	28.173^＊＊
观察组	93.44±6.78	37.71±2.38	54.989^＊＊	1.92±0.60	3.51±0.34	17.864^＊＊	2.68±0.49	5.36±0.19	34.935^＊＊
t	1.660	5.175^＊＊		0.748	4.035^＊＊		1.892	5.642^＊＊

组别	AR/[cmH₂O/（L·s）]			AOP/（cmH₂O）			Cdyn/（mL/cmH₂O）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	95.76±7.46	42.97±8.46	37.173^＊＊	2.00±0.54	3.85±0.52	18.496^＊＊	2.51±0.42	4.93±0.51	28.173^＊＊
观察组	93.44±6.78	37.71±2.38	54.989^＊＊	1.92±0.60	3.51±0.34	17.864^＊＊	2.68±0.49	5.36±0.19	34.935^＊＊
t	1.660	5.175^＊＊		0.748	4.035^＊＊		1.892	5.642^＊＊

组别	HR/（次/min）			MAP/（mmHg）			CVP/（cmH₂O）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	108.11±14.68	91.52±12.48	5.437^＊＊	91.05±13.89	84.65±4.09	3.278^＊	13.13±0.67	10.78±2.96	6.162^＊＊
观察组	106.21±6.43	95.77±11.55	5.903^＊＊	89.27±11.70	83.07±9.41	3.198^＊	12.89±0.83	9.91±2.46	8.533^＊＊
t	0.856	1.803		0.708	1.115		1.655	1.636

不同潮气量通气对重症肺炎患儿呼吸力学和血流动力学的影响

Study on the effects of different tidal volume ventilation on respiratory mechanics and hemodynamics in children with severe pneumonia

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 4

参考文献 20

相关文章 15

编辑推荐

Metrics

本文评价

[1]	金亮, 金爱, 王苓, 齐霄茹, 代琰, 苏海涛. 表面肌电生物反馈联合呼吸训练治疗脑卒中后吞咽障碍的疗效观察[J]. 天津医药, 2025, 53(7): 688-693.
[2]	余辉, 刘浩, 蔡凤丽, 赵婧, 白相森, 田国梁, 张含悦, 张丽媛. 基于声学信息检测阻塞性睡眠呼吸暂停的研究进展[J]. 天津医药, 2025, 53(7): 776-784.
[3]	贾建波, 孙根, 顾媛媛. 持续气道正压通气对合并阻塞性睡眠呼吸暂停综合征的脑梗死患者平均气道压及神经功能的影响[J]. 天津医药, 2025, 53(6): 639-643.
[4]	胡卓, 谢松波, 游诗伟. 序贯器官衰竭评分联合Clara细胞蛋白和血管生成素-2对脓毒症所致ARDS的预测价值[J]. 天津医药, 2025, 53(5): 519-522.
[5]	凡永军, 刘文芳, 卢亚超. 心室动脉偶联与脓毒症患者血流动力学的关系及对预后的预测价值[J]. 天津医药, 2025, 53(4): 402-406.
[6]	缪妍, 朱蕾, 樊元慧. 瑞马唑仑对全麻下斜视手术患儿苏醒质量的影响[J]. 天津医药, 2025, 53(4): 425-428.
[7]	杨丽亚, 郑丽, 李利红, 李亚永, 马将. 多巴丝肼联合呼吸训练在卒中后吞咽困难中的效果评价[J]. 天津医药, 2025, 53(3): 257-261.
[8]	王小亚, 张敏, 何晓刚. 己酮可可碱联合依达拉奉右莰醇治疗急性脑梗死的临床研究[J]. 天津医药, 2025, 53(2): 208-212.
[9]	戴瑶, 方向, 黄康, 冯洁, 刘敏, 伍松柏. HAT疗法治疗脓毒症休克的临床疗效观察[J]. 天津医药, 2024, 52(8): 825-829.
[10]	钱洪春, 张萍淑, 元小冬, 袁建新, 曹凌云, 段丽琴. 卒中伴阻塞性睡眠呼吸暂停患者认知功能损害与睡眠参数的关系[J]. 天津医药, 2024, 52(6): 619-624.
[11]	朱咏仪, 温博伦, 吴青霖, 梁少玲, 宗银东. 右美托咪定对孕产妇椎管内麻醉期间寒战及血流动力学的影响[J]. 天津医药, 2024, 52(4): 387-390.
[12]	刘丹, 万南生, 王杰, 句仁华, 谢巍, 田羽, 冯靖. 多导睡眠图辅助药物诱导睡眠内镜正压呼吸机压力滴定的操作要点[J]. 天津医药, 2024, 52(3): 324-326.
[13]	钟晓倩, 孙高悦, 张倩倩, 李云. 驱动压导向的个体化呼气末正压通气对行腹腔镜胃癌根治术老年患者的肺保护作用[J]. 天津医药, 2024, 52(2): 188-192.
[14]	屠昌明, 田园, 汪鹏程, 任鹏, 赵寅生. SII、RAR与AECOPD患者病情严重程度及并发呼吸衰竭的关系[J]. 天津医药, 2024, 52(12): 1317-1321.
[15]	梁耀冰, 符振华, 赵梓粤, 罗剑明, 程冬瑀, 姜海行, 覃山羽. 高甘油三酯血症性急性胰腺炎并发急性呼吸衰竭危险因素及预测模型的建立[J]. 天津医药, 2024, 52(11): 1183-1187.

组别	IL-6/（ng/L）			IL-8/（μg/L）			TNF-α/（μg/L）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	207.88±30.86	132.46±26.13	12.170^＊＊	12.14±1.34	9.83±0.48	11.830^＊＊	13.16±3.57	10.75±2.50	4.153^＊＊
观察组	205.55±28.63	111.21±9.86	22.909^＊＊	12.44±1.34	7.64±0.72	22.141^＊＊	14.02±3.12	8.87±1.03	10.663^＊＊
t	0.398	5.487^＊＊		1.139	18.216^＊＊		1.317	5.010^＊＊

组别	IL-6/（ng/L）			IL-8/（μg/L）			TNF-α/（μg/L）
组别	治疗前	治疗后	t	治疗前	治疗后	t	治疗前	治疗后	t
对照组	207.88±30.86	132.46±26.13	12.170^＊＊	12.14±1.34	9.83±0.48	11.830^＊＊	13.16±3.57	10.75±2.50	4.153^＊＊
观察组	205.55±28.63	111.21±9.86	22.909^＊＊	12.44±1.34	7.64±0.72	22.141^＊＊	14.02±3.12	8.87±1.03	10.663^＊＊
t	0.398	5.487^＊＊		1.139	18.216^＊＊		1.317	5.010^＊＊