呼气末二氧化碳分压对高流量辅助通气治疗支气管肺炎患儿预防低氧血症的价值

The guiding value of end-expiratory partial pressure of carbon dioxide in the prevention of hypoxemia in children with bronchopneumonia treated with high flow assisted ventilation

摘要

目的 探讨呼气末二氧化碳分压(PETCO₂)对高流量辅助通气治疗支气管肺炎患儿低氧血症预防的指导价值.方法 选取2021年1月至2023年11月雅安市人民医院收治的支气管肺炎患儿269例为研究对象,均行高流量辅助通气治疗.根据是否并发低氧血症分为低氧血症组(n=97)和非低氧血症组(n=172).比较两组支气管肺炎患儿的一般资料、血气分析指标,采用广义估计方程(GEE)模型分析支气管肺炎患儿发生低氧血症的影响因素.根据低氧血症严重程度分级标准将低氧血症组的支气管肺炎患儿分为轻度组和中重度组,比较两组的一般资料,分析PETCO₂与低氧血症严重程度的剂量反应关系.结果 与非低氧血症组相比,低氧血症组的年龄较小,而CRP、Fib、DD、ESR、LDH较高(t=2.436、9.635、3.530、14.384、9.137、10.486,P<0.05).治疗48h后,非低氧血症组SaO₂、PaO₂水平均显著高于低氧血症组,PETCO₂、pH、PaCO₂水平显著低于低氧血症组(t=6.220、13.223、6.861、7.437、5.325,P<0.05).PaO₂、pH、SaO₂治疗48h、36h、24h、12h显著高于0h,而PETCO₂、PaCO₂疗治48h、36h、24h、12h显著低于0h,差异具有统计学意义(P<0.05).CRP、Fib、DD、ESR、LDH、SaO₂、PaO₂、PaCO₂、pH、PETCO₂均显著影响支气管肺炎患儿发生低氧血症(OR:1.810~3.554,P<0.05).与轻度组患儿相比,中重度组的年龄≤3岁、病程≥7d的占比及CRP、Fib、DD、PETCO₂、PaCO₂水平均更高,而SaO₂、pH、PaO₂水平均更低(P<0.05).限制性立方样条模型结果显示,PETCO₂水平和支气管肺炎患儿低氧血症严重程度之间的关联呈非线性剂量反应关系(P<0.001).结论 PETCO₂对预防支气管肺炎患儿高流量辅助通气治疗中的低氧血症具有指导价值,其水平与低氧血症严重程度相关,高PETCO₂会增加低氧血症风险.

Abstract

Objective To investigate the guiding value of end-tidal carbon dioxide partial pressure (PETCO ₂) in preventing hypoxemia in children with bronchopneumonia undergoing high-flow oxygen therapy. Methods A total of 269 children with bronchopneumonia admitted to Ya'an People's Hospital from January 2021 to November 2023 were included in the study, all of whom received high-flow oxygen therapy. Based on the presence or absence of hypoxemia, patients were divided into the hypoxemia group (n=97) and the non-hypoxemia group (n=172). General clinical data and blood gas analysis parameters were compared between the two groups. A generalized estimating equation (GEE) model was used to analyze the influencing factors of hypoxemia in children with bronchopneumonia. According to the classification criteria of hypoxemia severity, children in the hypoxemia group were further divided into a mild group and a moderate-to-severe group. General clinical data were compared between the two groups, and the dose-response relationship between PETCO ₂ and hypoxemia severity was analyzed. Results Compared with the non-hypoxemia group, children in the hypoxemia group were younger and had higher levels of CRP, Fib, DD, ESR, and LDH (t=2.436, 9.635, 3.530, 14.384, 9.137 and 10.486, respectively, P<0.05). After 48 hours of treatment, SaO ₂ and PaO ₂ levels were significantly higher in the non-hypoxemia group than in the hypoxemia group, while PETCO ₂, pH, and PaCO ₂ levels were significantly lower (t=6.220, 13.223, 6.861, 7.437 and 5.325, respectively, P<0.05). Compared with baseline (0h), PaO ₂, pH, and SaO ₂ levels at 12h, 24h, 36h, and 48h were significantly increased, whereas PETCO ₂ and PaCO ₂ levels were significantly decreased (P<0.05). CRP, Fib, DD, ESR, LDH, SaO ₂, PaO ₂, PaCO ₂, pH, and PETCO ₂ significantly influenced the occurrence of hypoxemia in children with bronchopneumonia (OR: 1.810-3.554, P<0.05). Compared with children in the mild group, those in the moderate-to-severe group had a higher proportion of age ≤3 years and disease duration ≥7 days, as well as higher levels of CRP, Fib, DD, PETCO ₂, and PaCO ₂, but lower levels of SaO ₂, pH, and PaO ₂ (P<0.05). A restricted cubic spline model showed a nonlinear dose-response relationship between PETCO ₂ levels and hypoxemia severity in children with bronchopneumonia (P<0.001). Conclusion PETCO ₂ has guiding value in preventing hypoxemia during high-flow oxygen therapy in children with bronchopneumonia. The level of PETCO ₂ is nonlinearly associated with hypoxemia severity, and elevated PETCO ₂ increases the risk of hypoxemia.

关键词

患儿 / 支气管肺炎 / 低氧血症 / 呼气末二氧化碳分压 / 高流量辅助通气

Key words

child / bronchopneumonia / hypoxemia / end-tidal carbon dioxide partial pressure / high-flow oxygen therapy

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