高频振荡机械通气治疗5例甲型H1N1流感患者呼吸衰竭的临床体会  

Clinical experience in treatment of five H1N1 flu patients with respiratory failure with high-frequency oscillatory mechanical ventilation

作　　者：张志刚[1] 石斌[1] 李斌[1] 刘丽平[1] 郭鸿[1] 尹超[1] 侯启亮[1] 

机构地区：[1]兰州大学第一医院重症医学科,兰州730000

出　　处：《解放军医学杂志》2011年第8期800-803,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨高频振荡通气（HFOV）在甲型H1N1流感患者呼吸衰竭治疗中的应用价值及安全性。方法采用自身对照研究,5例呼吸衰竭甲型H1N1流感患者经常规机械通气（CMV）治疗无效后改用HFOV治疗,观察治疗前后血气[氧分压（PaO2）、二氧化碳分压（PCO2）、pH]、呼吸力学指标[氧浓度（FiO2）、平均气道压（Paw）、静态顺应（Cst）、氧合指数（PaO2/FiO2）]的变化,分析肺活检病理资料及临床治疗效果。结果经HFOV治疗后6~8h,3例患者氧合较前改善,24~48h后明显改善,48~72h后改为CMV,144h后成功脱机;2例患者经HFOV治疗,8h内病情恶化改用CMV治疗,1例75h后死亡,1例经体外膜氧合（ECMO）治疗145h后死亡。结论 HFOV可明显改善甲型H1N1流感呼吸衰竭患者的预后,与CMV序贯治疗可以降低并发症发生率病死率。Objective To investigate the application and safety of high-frequency oscillation ventilation（HFOV） in the treatment of patients suffering from H1N1 influenza with respiratory failure.Methods Self-control study was conducted.The treatment of five H1N1 influenza patients with respiratory failure was switched to HFOV after failure of conventional mechanical ventilation（CMV）.Blood gas [partial pressure of oxygen（PaO2）,partial pressure of carbon dioxide（PCO2）,pH],respiratory mechanics indices [oxygen concentration（FiO2）,mean airway pressure（Paw）,static response（Cst）,oxygenation index（PaO2/FiO2）] before and after treatment were observed.Lung biopsy and clinical treatment data were also analyzed.Results Oxygenation was improved in 3 patients 6 to 8 hours after HFOV treatment,and marked improvement was observed after 24-48h.48-72h later,HFOV was replaced by CMV,and the patients weaned from mechanical ventilation successfully at 144h.In two patients symptoms were exacerbated after HFOV for 8 hours and the treatment was switched to CMV.Among them one died at 75h,and another one was treated with extracorporeal membrane oxygenation（ECMO） and died at 145h.Conclusions HFOV can significantly improve the outcome of H1N1 flu patients with respiratory failure.The sequential treatment with HFOV followed by CMV can reduce complications and mortality.

关 键 词：高频通气 流感病毒A型 H1N1亚型 呼吸功能不全 

分 类 号：R511.7[医药卫生—内科学]