摘要目的:探讨以肺部感染控制窗（PIC）指导的序贯机械通气治疗重症肺炎合并呼吸衰竭患儿的疗效，为临床疾病治疗提供理论依据。方法:选取2016年1月至2017年12月于建德市第二人民医院就诊并行机械通气的儿童肺炎合并呼吸衰竭患儿300例为研究对象，依据患儿入院先后顺序分为对照组和观察组，每组150例，对照组患儿接受传统持续有创机械通气治疗，观察组患儿接受以PIC窗为指导的有创-无创序贯机械通气治疗，比较两组患儿有创通气时间、重症监护病房（ICU）住院时间、呼气时间（TE）、吸气时间（TI）及达到呼气峰流速时间（TPTEF）、血气分析指标及呼吸机相关性肺炎、肺出血及气胸并发症发生情况。结果:观察组患儿治疗后动脉血氧分压（PaO 2）［（97.31±6.39）mmHg比（86.24±10.92）mmHg］、氧合指数（PaO 2/FiO 2）［（280.78±40.12）mmHg比（210.75±40.11）mmHg］、pH值（7.44±0.01比7.27±0.04）、呼气时间（TE）［（1.18±0.12）s比（0.89±0.11）s］、吸气时间（TI）［（0.79±0.09）s比（0.39±0.01）s］、达到呼气峰流速时间（TPTEF）［（0.41±0.02）s比（0.21±0.03）s］及撤机成功率（96.67%比78.67%）均显著高于对照组，差异均有统计学意义（ t=13.287、130.381、9.231、6.353、9.793、10.131，χ 2=22.475，均 P<0.001）；观察组患儿治疗后动脉二氧化碳分压（PaCO 2）值［（39.76±5.49）mmHg比（46.72±7.51）mmHg］、有创通气时间［（8.11±3.21）d比（17.24±4.52）d］及ICU住院时间［（15.03±2.94）d比（21.94±4.29）d］、呼吸机相关性肺炎（1.33%比6.67%）、肺出血（0.00%比2.67%）及气胸（2.67%比8.00%）的发生率均显著低于对照组，差异均有统计学意义（ t=14.798、10.136、9.962，χ 2=5.556、4.054、4.225，均 P<0.05）。 结论:以PIC窗指导的序贯机械通气治疗儿童重症肺炎合并呼吸衰竭可获得较好疗效，血气指标改善明显，安全性高。

abstractsObjective:To investigate the efficacy of sequential mechanical ventilation based on pulmonary infection control window in the treatment of severe pneumonia complicated by respiratory failure in children.Methods:A total of 300 children with pneumonia complicated with respiratory failure who received mechanical ventilation in Jiande Second People's Hospital from January 2016 to December 2017 were included in this study. They were assigned to receive either conventional continuous invasive mechanical ventilation (control group, n = 150) or invasive- noninvasive sequential mechanical ventilation based on pulmonary infection control window (observation group, n = 150) according to the order of admission. Invasive ventilation time, intensive care unit stay, expiratory time, inspiratory time and time to peak tidal expiratory flow, blood gas analysis indexes, incidence of ventilator-associated pneumonia, pulmonary hemorrhage and pneumothorax were compared between the two groups. Results:After treatment, PaO 2 value [(97.31 ± 6.39) mmHg vs. (86.24 ± 10.92) mmHg], PaO 2/FiO 2 [(280.78 ± 40.12) mmHg vs. (210.75 ± 40.11) mmHg], pH value [(7.44 ± 0.01) vs. (7.27 ± 0.04)], expiratory time [(1.18 ± 0.12) s vs. (0.89 ± 0.11) s], inspiratory time [(0.79 ± 0.09) s vs. (0.39 ± 0.09) s], time to peak tidal expiratory flow [(0.41 ± 0.02) s vs. (0.21 ± 0.03) s] and the rate of successful weaning (96.67% vs. 78.67%) in the observation were significantly higher than those in the control group ( t = 13.287, 130.381, 9.231, 6.353, 9.793, 10.131, χ2 = 22.475, all P < 0.001). After treatment, PaCO 2 value [(39.76 ± 5.49) mmHg vs. (46.72 ± 7.51) mmHg], invasive ventilation time [(8.11 ± 3.21) d vs. (17.24 ± 4.52) d], intensive care unit stay [(15.03 ± 2.94) d vs. (21.94 ± 4.29) d], the proportion of children having ventilator-associated pneumonia (1.33% vs. 6.67%), the proportion of children having pulmonary hemorrhage (0.00% vs. 2.67%) and the proportion of children having pneumothorax (2.67% vs. 8.00%) in the observation group were significantly higher than those in the control group ( t = 14.798, 10.136, 9.962, χ2 = 5.556, 4.054, 4.225, all P < 0.05). Conclusion:Sequential mechanical ventilation based on pulmonary infection control window for the treatment of severe pneumonia complicated by respiratory failure in children can achieve good curative effects through greatly improving blood gas index and is highly safe.