高频振荡通气治疗新生儿胎粪吸入综合征  

High-frequency oscillatory ventilation for treating neonatal meconium aspiration syndrome

作　　者：曾健生[1] 李克华[1] 崔玉涛[1] 刘红[1] 陈贤楠[1] 樊寻梅[1] 

机构地区：[1]首都医科大学附属北京儿童医院急救中心,100045

出　　处：《中华儿科杂志》2001年第4期195-197,共3页Chinese Journal of Pediatrics

摘　　要：目的　评价高频振荡通气 (HFOV)结合肺复张策略治疗新生儿胎粪吸入综合征的有效性及安全性。方法　采用高频振荡通气治疗 9例胎粪吸入综合征患儿 ,通过逐渐增加平均气道压实施肺复张策略 ,以实现吸入氧体积分数≤ 0 4时 ,经皮氧饱和度≥ 0 9,同时调节振荡压力幅度及振荡频率 ,使PaCO2 位于 35～ 45mmHg(1mmHg =0 133kPa)。治疗过程中监测心率、血压、动脉血气及氧合指数。结果　 8例患儿在施行HFOV治疗 48h后 ,平均气道压由 (2 2± 3)cmH2 O降至 (15± 4)cmH2 O(F =3 5 2 ,P <0 0 5 ) ;吸入氧体积分数由 0 5 7± 0 30降至 0 37± 0 19(F =2 72 ,P <0 0 5 ) ;用HFOV后肺部氧合得到改善 ,氧合指数由 13 7± 3 1降至 6 1± 2 2 (F =3 5 8,P <0 0 5 ) ;振荡压力幅度由(48± 7)cmH2 O逐渐降至 (41± 7)cmH2 O ,但差异无显著性 (F =1 98,P >0 0 5 )。治疗过程中心率、血压无明显变化。结论　HFOV对新生儿胎粪吸入综合征是安全有效的 ,实行肺复张策略能改善肺部氧合 ,对心血管无明显副作用。Objective The high frequency oscillatory ventilation (HFOV) has been proved effective both on maintaining gas exchange and decreasing the frequency of chronic lung diseases in neonates with respiratory distress syndrome. The present study aimed to evaluate the safety and effectiveness of HFOV along with the protocol of recruiting and maintaining the optimal lung volume in neonates with meconium aspiration syndrome. Methods Nine neonates (7 males and 2 females) with meconium aspiration syndrome were managed with HFOV. The median age was 12 h (2 40 h), the median gestational age was 41 weeks (40 42 weeks), and the median birth weight was 3 640 g (2 750 4 550 g). During HFOV, the lung volume recruitment strategy was performed, that is, to increase the mean airway pressure and lung volume, and to achieve the arterial oxygen saturation ≥90% and FiO 2 ≤0.4. Modulation of PaCO 2 was accomplished by either varying amplitude pressure or changing oscillatory frequency. The target PaCO 2 was 35 45 mmHg (1 mmHg=0.133 kPa). The heart rate, arterial blood pressure, transcutaneous oxygen saturation, arterial blood gas analysis and the oxygenation index were monitored during the course of the high frequency protocol. Results Eight neonates demonstrated effective with HFOV by improving oxygenation and maintaining gas exchange. The duration of HFOV varied from 2 to 8 (median 5) days. During 48 hours after initiating HFOV, there were steady reductions in both mean airway pressure and FiO 2 .The mean airway pressure decreased from (22±3) cmH 2O to (15±4) cmH 2O ( F =3.52, P <0.05), and FiO 2 decreased from 0 57±0 30 to 0 37±0 19 ( F =2.72, P <0.05). After application of HFOV, there was prompt improvement in oxygenation. The oxygenation index decreased from 13.7±3.1 to 6.1±2.2 ( F =3.58, P <0.05 ). No statistically significant changes was observed in the amplitude pressure, though the median amplitude pressure decreased from (48±7) cmH 2O to (41±7) cmH 2O ( F =1.98, P >0.05). No

关 键 词：胎粪吸入综合征 高频通气 呼吸功能不全 婴儿 新生儿 HFOV 肺复张 

分 类 号：R722.19[医药卫生—儿科]