高频震荡通气治疗先天性心脏病术后重症ARDS32例效果观察  

Observations on high-frequency oscillatory ventilation effects in pediatric patients with acute respiratory distress syndrome after congenital heart surgery

作　　者：王旭[1] 张燕搏[1] 曾敏[1] 段雷雷[1] 李胜利[1] 王珊[1] 

机构地区：[1]中国医学科学院阜外心血管病医院,北京100037

出　　处：《山东医药》2012年第3期22-24,共3页Shandong Medical Journal

基　　金：首都医学发展科研基金项目(2009-1008)

摘　　要：目的探讨高频震荡通气(HFOV)对小儿心脏手术后重症ARDS的治疗效果。方法对32例心脏手术后常频通气(CMV)治疗无效的重症ARDS患儿行HFOV治疗,设置相应的参数并行氧合、通气管理,每次吸痰后行肺复张。观察治疗前后血气指标变化、HFOV治疗时间、肺复张期间循环指标变化、整体治疗期间并发症发生情况及患儿存活情况。结果 HFOV治疗后通气及气体交换在较短的时间内改善,12～48 h血气相关指标PaO2、PaCO2、吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)均明显改善且稳定。HFOV治疗时间43～238(128.5±67.49)h,肺复张期间循环指标未出现异常变化,末梢血氧饱和度快速恢复至吸痰前水平,呼吸机的吸氧浓度快速降低。整体治疗期间出现气胸9例,均安置胸腔闭式引流。本组患儿存活21例(65.6%),死亡11例。结论 HFOV对CMV治疗无效的重症ARDS能在较短时间内改善通气及气体交换,可作为小儿心脏术后重症ARDS的重要抢救措施。Objective To evaluate the effectiveness of high-frequency oscillatory ventilation （HFOV） in pediatric patients with acute respiratory distress syndrome （ARDS） after congenital heart surgery. Methods Thirty-two pediatric patients were treated with HFOV for failing conventional mechanical ventilation （ CMV）, ventilation and oxygen parameters were adjusted, and lung recruitment maneuvers was applied after tracheal suction. Changes of blood gas indexes, HFOV treating time, changes of cycle indexes during re-ex-pansion of the lung, complications and survival rate were observed. Results After 12 to 48 hs of HFOV, PaO2, PaCO2 , FiO2 and PaO2/FiO2 were all improved significantly and remained within the target range thereafter. The mean duration of HFOV was 43-238 （ 128.5 ± 67.49 ） hs. Barotrauma necessitating the insertion of the chest tube were appeared in 9 children. Twenty-one children （65.6%） were successfully weaned and survived to discharge, 11 children died . Conclusion In pediatric patients with acute respiratory distress syndrome failing conventional ventilation, HFOV can improve ventilation and gas exchange in a rapid fashion, and can be used as rescue treatment for some pediatric ARDS patients after congenital heart surgery. Ke

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：R563.8[医药卫生—呼吸系统]