小儿心脏术后高频振荡通气应用的改进及临床效果  

New strategy for treatment of acute lung injury with high-frequency oscillatory ventilation after open heart surgery in children with congenital heart disease

作　　者：李胜利[1] 曾敏[1] 王旭[1] 李守军[2] 闫军[2] 

机构地区：[1]中国医学科学院阜外心血管病医院小儿心脏中心PICU,100037 [2]中国医学科学院阜外心血管病医院外科,100037

出　　处：《新医学》2011年第8期501-503,共3页Journal of New Medicine

摘　　要：目的:评价高频震荡通气(HFOV)新策略治疗小儿心脏术后ARDS的临床效果。方法:2007年6月-2010年12月所有HFOV的患儿,根据是否应用新策略分为2组,Ⅰ组为旧策略组,Ⅱ组为新策略组,比较两组在使用HFOV策略上的差异及死亡率的差别。新策略主要包括:综合评估病情、及早使用HFOV,尽量降低HFOV条件、减轻肺损伤。结果:Ⅱ组HFOV时机早于Ⅰ组,高频主要条件低于Ⅰ组;Ⅰ组PaCO2低于Ⅱ组,PaO2高于Ⅱ组;Ⅰ组死亡率66.7%,Ⅱ组死亡率33.3%,两组比较差异有统计学意义。结论:更早启用HFOV通气,通气时较低的通气条件(震荡压、频率),可以明显提高小儿先天性心脏病术后ARDS的早期存活率。Objective： To evaluate the result of new strategy of HFOV to treat ARDS in children with congenital heart disease who underwent heart surgery. Methods： From June 2007 to December 2010, the patients treated with HFOV were divided into two groups. Group Ⅰ is before 2009 when HFOV was operated following old trategy, and group Ⅱ is after 2009 when HFOV was operated following new strategy. The new strategy includes early initiation of HFOV, adjustment of the parameter of HFOV and attenuation of lung injury. Results： The mobility of group Ⅱ is lower than group Ⅰ. The duration of ICU stay in group Ⅰ is shorter than that of group It. The parameter of HFOV in group Ⅱ is lower than in group Ⅰ . The mean PaCO2 is lower in group I than in group Ⅱ , while the mean PaO2 is higher in group Ⅰ than in group Ⅱ. The differences mentioned above are all statistically significant. Conclusion： New strategy applied in the HFOV in the children with ARDS undergoing heart surgery shows encour-aged early result.

关 键 词：高频震荡通气 先天性心脏病 急性呼吸窘迫综合征 

分 类 号：R726.5[医药卫生—儿科]