Estimation Of Three Kinds Of Oxygen Therapy In The Treatment Of Severe Pneumonia In Children By Differential Pressure Of Alveoli-arterial Oxygen

Objective:At present,effective oxygen therapy is needed for children with severe pneumonia and respiratory failure,but there is still controversy about the way to choose oxygen therapy.In this study,the value of alveolar arterial oxygen pressure difference（P（A-a）O₂）and oxygen index（OI=PaO₂/FiO₂）was evaluated in children with severe pneumonia combined with respiratory failure,and the effects of mask oxygen inhalation,noninvasive mechanical ventilation and tracheal intubation on the prognosis of severe pneumonia complicated with respiratory failure were evaluated.Methods:The control group:30 children with non pulmonary infection;the observation group:90 cases with severe pneumonia and respiratory failure;（1）according to the death risk score PRISM was divided into the observation group A（<15）,the observation group B（>15 score）,each group of 45 cases,and selected 30 cases of non pulmonary infection children as the control group.Monitor P（A-a）O₂ and PaO₂/FiO₂.（2）according to different oxygen therapy,they were divided into face mask oxygen inhalation group,noninvasive mechanical ventilation group and endotracheal intubation mechanical ventilation group,30 cases in each group.Monitoring of 1h,3h,6h,12h,24h and 36h at all time points P（A-a）O₂,arterial partial pressure of oxygen（PaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）and blood oxygen saturation（SpO₂）,vital signs,lung function,serum inflammatory factors and aeration quality;Observation of clinical curative effect and prognosis.Results:1.P（A-a）O₂ in group A and B was higher than control group（P<0.05）,respectively.PaO₂/FiO₂ in group A and B was lower than control group（P<0.05）,respectively.2.On admission,there was no significant difference in the indexes of P（A-a）O₂,PaO₂,PaCO₂,SpO₂ and PaO₂/FiO₂ among the three groups of oxygen therapy children（P>0.05）.It was showed that the P（A-a）O₂,PaO₂,PaCO₂ decreased dramatically 36h after treatment,while the level of SpO₂and PaO₂/FiO₂ was sharply increased.There were significant differences in the tracheal intubation mechanical ventilation group and non invasive mechanical ventilation group,compared with the mask oxygen therapy group（P<0.05）,respectively.3.There was no statistical difference between the three groups of oxygen therapy children’s life signs（P>0.05）.The improvement of life signs in the non invasive mechanical ventilation group was the most obvious after the treatment of 36h,and the difference between each time point was statistically significant（P<0.05）.4.The total effective rate of the non invasive mechanical ventilation group was 80%,which was significantly higher than that of 56.55%in the mask oxygen therapy group（P<0.05）,and the non invasive mechanical ventilation group was lower than 86.67%of the tracheal intubation mechanical ventilation group,but the difference was not obvious（P>0.05）.5.Forced vital capacity（FVC）,peak expiratory flow（PEF）,forced expiratory volume in 1s（FEV1）in 6h,12h,24h and 36h after treatment increased significantly in three groups,the increase level of the mask oxygen inhalation group was the most obvious,lower than the other two groups（P<0.05）.6.There were significant differences in the levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,soluble triggering receptor expressed on myeloidcell-1（sTREM-1）,interleukin-4（IL-4）,interleukin-10（IL-10）,interleukin-13（IL-13）at each time point of three groups of oxygen therapy children（P<0.05）.The levels of inflammatory factors after 12h,24h and 36h after treatment in the non invasive mechanical ventilation group were significantly lower than those of the mask oxygen inhalation group and the tracheal intubation mechanical ventilation group（P<0.05）.7.The incidence of complications in the mask oxygen therapy group,the noninvasive mechanical ventilation group and the tracheal intubation mechanical ventilation group were（6.66%）,（6.66%）and（49.97%）,respectively.And the success rate of weaning were 50%,90%and 70%,respectively.The difference of incidence of complications between the non invasive mechanical ventilation group and mask oxygen therapy group have no statistics significance（P>0.05）,but the success rate of weaning of non invasive mechanical ventilation group was higher than that of mask oxygen therapy group,the difference was statistically significant（X²=6.112,P=0.013）.The success rate of weaning of non invasive mechanical ventilation group was slightly higher than that of tracheal intubation mechanical ventilation group,the difference was no statistical significance between the two groups.But the complications incidence in non invasive mechanical ventilation group was lower than that in tracheal intubation mechanical ventilation group,the different is significantly（P<0.001）.The success rate of the non invasive mechanical ventilation group was significantly better than that of the other two groups,with significant difference（P<0.05）Conclusion:1.Dynamic monitoring of P（A-a）O₂ and PaO₂/FiO₂ can help to evaluate the severity of severe pneumonia and respiratory failure in children,and can be used as an important auxiliary index for judging curative effect.2.The early use of non-invasive mechanical ventilation in children with severe pneumonia complicated with respiratory failure is effective and helpful to improve Oxygenation of lung,promote the recovery of lung function,reduce the inflammatory response,and improve the clinical prognosis.