高频振荡通气治疗小儿先天性心脏病术后严重肺出血的有效性及安全性

Effectiveness and safety of high frequency oscillation ventilation in serious pulmonary hemorrhaege after surgical re-pair of congenital heart disease

目的探讨高频振荡呼吸机（HFOV）在治疗小儿先天性心脏病（CHD）术后严重肺出血的有效性及安全性。方法回顾性分析2010年1月至2012年7月14例CHD术中或术后出现严重肺出血患儿的临床资料，患儿分别应用常频呼吸机（CMV）及HFOV。14例患儿月龄1～24个月，平均（6．5±5．9）个月；体质量3．7—10．0kg，平均（5．8±1．7）kg。以开始应用高频振荡呼吸机的日期2011年5月为时间点将14例患儿分为两组：2011年5月前应用常频呼吸机通气的为CMV组，共6例；2011年5月后应用高频振荡呼吸机通气的为HFOV组，共8例。记录两组患儿机械通气时心率（HR）、动脉血压（ABP）、中心静脉压（CVP）、正性肌力药物评分（IS）、动脉血气分析变化、氧合指数（OI）、病情转归及并发症情况。结果HFOV组患儿机械通气2h后氧合显著改善，血气氧分压[（84．8±60．4）mmHg对（28．1±5．6）mmHg（1mmHg=0．133kPa）]及氧合指数[（39．3±31．1）对（110．0±19．9）]均显著优于CMV组患儿；二氧化碳分压差异无统计学意义。应用HFOV过程中CVP较应用前升高（P〈0．05）；动脉血压无明显变化，8例患儿均无需特别调整正肌力药物。CMV组患儿中4例（66．7％，4／6）治疗无效死亡，HFOV组3例（37．5％，3／8）死亡。结论先天性心脏病术后并发严重肺出血的患儿应用HFOV可有效、快速改善氧合功能，不影响患儿血流动力学指标，严重并发症少，安全性高。

Objective Experience with high-frequency oscillatory ventilation （HFOV） after congenital cardiac surgery is limited. The aim of the present study was to investigate the effect and safety of high frequency oscillation ventilation for patients with serious pulmonary hemorrhaege after surgical repair of congenital heart disease （CHD）. Methods The patients with seri-ous pulmonary hemorrhaege after surgical repair of CHD using conventional mechanical ventilation or high frequency oscillation ventilation were retrospectively analyzed. From January 2010 to July 2012, there were fourteen patients suffered from serious pulmonary hemorrhaege after surgical repair of congenital heart disease in our hospital and all involved in this study. The mean age was （6.5 ± 5.9 ） months （ ranged from 1 to 24 months） and the mean body weight was （ 5.8 ± 1.7 ） kg（ ranged from 3.7 to 10 kg）. Before May 2011 patients with serious pulmonary hemorrhaege after surgical repair of congenital heart disease were treated with conventional mechanical ventilation（ CMV group, n = 6 ）, and after May 2011 high frequency oscillation ventilation （ HFOV group, n = 8 ） instead. The diagnoses were pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries 7 cases, tetralogy of Fallot with imbalance pulmonary arterial development 5 cases, and total anomalous pul- monary venous connection 2 cases. Heart rate, arterial blood pressure, central venous pressure （CVP）, inostropie score, the blood gas analysis, the oxygenation index （OI）, the outcomes and complications during both mechanical ventilations were all recorded. Results The PaO2 , OI and systolic blood pressure of patients in HFOV group were significant higher than those in CMV group after 2 hours ventilation. There was no statistical difference in PCO2 , diastolic blood pressure and inostropic score after 1, 2, 4, 8, 24 hours ventilation. All cases had no significant changes in hemodynamics. CVP of patients in HFOV group increased slightly（ P 〈0.05 ） , but there was no statistical difference in arterial blood pressure. Four patients died in CMV group. The mortality of CMV group and HFOV group was 66.7% （4/6） and 37.5% （3/8, one with pulmonary venous obstru-tion, one with tracheobronchial blocked, the other with re-hemorrhaege） respectively. The mortality of HFOV group was no sig- nificantly different from that of CMV group. Conclusion Compared to CMV, using HFOV achieved greater oxygenation func-tion in patients with serious pulmonary hemorrhaege after surgical repair of CHD rapidly, had no significant changes in hemody-namics and rare serious complications. HFOV was effective and safe for patients with serious pulmonary hemorrhaege after sur-gical repair of congenital heart disease.