高频振荡通气在严重肺挫伤所致顽固性低氧血症中应用研究

Studyon the application of high frequency oscillatory ventilation in patients with refractory hypoxemia due to severe pulmonary contusion

目的研究应用高频振荡通气（HFOV）治疗严重肺挫伤所致顽固性低氧血症的疗效。方法在不影响正常临床治疗前提下，首先采用常频呼吸机无创通气，当出现顽固性低氧血症时，给予充分镇静、肌松，气管插管或气管切开，使用HFOV行有创通气。并对18例肺挫伤患者使用HFOV前后的PCO2、PO2、MAP、EVLW、平均气道压、SpO2、呼吸道血性分泌物；床边胸片以及患者的气管插管时间、使用呼吸机时间、住ICU时间、抢救成功率等重要临床参数进行监测统计，并与常频通气进行对照。结果严重肺挫伤使用HFOV前后的PCO2、PO2、MAP、EVLw、平均气道压、SpO2以及呼吸道血性分泌物、床边胸片、气管插管时间、使用呼吸机时间、住ICU时间等重要临床参数均有改善，但远期抢救成功率与常频通气（CMV）对照差异无统计学意义。结论HFOV对严重肺挫伤所致顽固性低氧血症有显著治疗作用。不仅可以降低气道压力，改善肺氧合而且还可以减少呼吸运动幅度使肺泡处于相对稳定的扩张状态，减少肺出血、渗出，有利于肺挫伤的愈合，对提高治疗顽固性低氧血症有重要临床指导意义。

Objective To explore the effect of high frequency oscillatory ventilation （HFOV） for treatment of refractory hypoxemia due to severe pulmonary contusion. Methods A total of 18 patients who suffered from refractory hypoxemia participated in the study. On top of the normal treatment, the noninvasive conventional mechanical ventilation was given to the patients before using sufficient sedative, muscle relaxant to intubate the trachea or carry out tracheotomy, and HFOV was applied for invasive mechanical ventilation when the refractory hypoxemia occurred. All the 18 patients＇ important clinical parameters were monitored and analyzed, including PCO2, PO2, MAP, EVLW, SpO2, respiratory tract bloody secretion and bedside radiography before and after the treatment of HFOV was performed, as well as tracheal intubation time, mechanical ventilation time, ICU monitoring time and success ratio of rescue. Results It demonstrated significant differences in values of PCO2, PO~, MAP, EVLW, Map, SpO2, respiratory tract bloody secretion and bedside radiography before and after the treatment of HFOV, as well as tracheal intubation time, mechanical ventilation time, ICU monitoring time and success ratio of rescue. Conclusion HFOV is considered being effective in treat refractory hypoxemia. Not only does it reduce airway pressure and improve lung oxygenation, but it also reduces the amplitude of breathing motion and stabilizes alveolar expansion which helps heal pulmonary contusion.