高频通气治疗新生儿重症呼吸衰竭

High frequency ventilation in treatment of infants with severe respiratory failure

目的 评价高频通气 (HFV)治疗新生儿重症呼吸衰竭的疗效。方法 37例新生儿重症呼吸衰竭患儿 ,因在常频通气 (CMV)治疗过程中出现FiO2 ≥ 0 8,平均气道压≥ 10cmH2 O ,持续 2h以上氧饱和度≤ 90 %或胸片示肺气漏或持续高碳酸血症而启用HFV。记录HFV开始时及治疗后 6、12、2 4h的FiO2 、a A、OI、MAP、PIP、振幅参数。结果 HFV治疗成功组 2 2例 ,HFV治疗失败组 15例。成功组HFV治疗 12h后 ,FiO2 下降 (P <0 0 5 ) ;a A有上升 (P <0 0 5 ) ;OI有显著下降 (P <0 0 1)。失败组HFV治疗 12h后FiO2 无明显变化 ;a A在治疗后 12h无好转 ,2 4h有上升 (P <0 0 5 ) ;OI在HFV治疗后 6h无好转 ,12h后逐渐下降 ,但无统计学意义。结论 应用CMV疗效不佳的新生儿重症呼吸衰竭改用HFV是呼吸序贯治疗的一种有效方法。

Objective To evluate the effectiveness of high frequcncy ventilation (HFV) in treatment of infants with severe respiratory failure.Methods 37 neonates with severe respiratory failure were changed by HFV because FiO2≥0.8,MAP≥10 cmH2O,TcSO2≤90% lasted more than 2 hours during the conventional mechnaical ventilation (CMV) or chest X-ray showed pneumothorax or continuous hypercapnia We recorded parameter;FiO2、a/A、OI、MAP、PIP and amplitude.Results 22 patients were treated successfully with HFV,15 patients failured.The treatment-success group:After the patients were treated with HFV for 12 h,FiO2 was declined (P<0.05),a/A was arised (P<0.05),OI was obviously descended(P<0.01).The treatment-failured group:After the patients were treated with HFV for 12 hours,FiO2 was not changed apparently,a/A was not increased,OI had no good trend after 6 hours.It had no significant difference,although OI was decreased after 12 hours.Conclusion Infants with severe respiratory failure in whom CMV failed,HFV is a valid alternative method.