先天性心脏病术后婴幼儿应用常频叠加呼气相高频通气  

Synchronized intermittent mandatory ventilation with expiratory high frequency ventilation in postoperative children with congenital heart defect

作　　者：贺彦[1] 陈焱[1] 刘文静[1] 崇梅[1] 冯昱[1] 张汀洲[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科重症监护室,100029

出　　处：《中国小儿急救医学》2015年第7期462-465,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的研究常频叠加呼气相高频通气模式在先天性心脏病术后合并重度呼吸窘迫综合征婴幼儿的应用效果。方法2012年1月至2013年8月，13例患儿，年龄（8．15±4．34）个月，体重（8．23±4．01）kg，应用常频叠加呼气相高频通气。原常频条件不变，呼气相高频振幅25—35A，频率7～9Hz。按高频前30min时患儿氧合指数（oxygenation index，OI，OI=MAP×FiO2／PaO2）分成2组，OI≥20为高OI组（n=5）和OI〈20为低OI组（n=8），观察两组患儿叠加高频后2、6、24、48h的OI、PaO2／FiO2、PaCO2。结果全组应用高频前0I为19．31±4．42，应用后2h、6h、24h、48h，01分别降低至18．77±5．18、16．00±5．22、14．77±6．56和13．92±6．53（P〈0．01）；PaCO2从（43．46±5．67）mmHg（1mmHg=0．133kPa）降低至（38．31±4．21）mmHg、（37．61±3．36）mmHg、（34．77±3．81）mmHg和（35．92±2．39）mmHg（P〈0．01）。高OI组5例患儿，应用高频前后OI无显著差异，3例死亡患儿均为高OI组。结论先天性心脏病婴幼儿术后合并重度急性呼吸窘迫综合征病死率高。应用常频叠加呼气相高频可能改善氧合，降低二氧化碳分压，OI〈20时，效果较好。Objective Some children with congenital heart defect would get serious acute respiratory distress syndrome in ICU postoperatively, which is a tough problem. We summarized the clinical effects of synchronized intermittent mandatory ventilation （SIMV） with expiratory high frequency ventilation （HFV） for these patients in our center. Methods A total of 13 pediatric patients, with（8. 15 ± 4. 34） months old and （8.23 ±4. 01） kg weight,used SIMV with expiratory HFV from Jan 2012 to Aug 2013. Keeping the original SIMV conditions unchanged,the expiratory oscillation amplitude were 25 to 35 Ann（A） and the oscillation frequency of 7 to 9 hertz（Hz）. All patients were divided into two groups to oxygenation index（OI） 30 min before HFV, high OI group （OI ≥20, n = 5 ） and low OI group （OI 〈 20, n = 8 ）. OI = MAP × FiO2/PaO2. The values of OI,PaO2/FiO2 and PaO2 of two groups were monitored before and at 2,6,24,48 h after HFV respectively. Results The values of OI of all 13 patients were 19. 31± 4.42 before HFV, and then decreased to 18.77±5.18,16.00±5.22,14.77±6. 56,and 13.92±6.53 respectively at 2,6,24 and 48 hours later （ P 〈 0.01 ）. But there was no significant difference of OI in high O1 group in different time points. The values of PaCt2 of all 13 patients were （43.46 ± 5.67 ） mmHg （ 1 mmHg = 0. 133 kPa） before HFV, and decreased to（38. 31 ±4.21） mmHg,（37. 61 ±3.36） mmHg,（34.77 ±3.81） mmHg,and（35.92±2.39） mmI-Ig respectively at 2,6,24, and 48 hours after HFV （P 〈 0. 01 ）. Three dead patients were all in high OI group. Conclusion The mortality rate of serious acute respiratory distress syndrome with congenital heart diseases postoperatively is high. SIMV with expiratory HFV can improve oxygenation and reduce carbon dioxide, and the effect is better when OI 〈 20.

关 键 词：先天性心脏病 高频通气 呼气相 婴幼儿 重度急性呼吸窘迫综合征 应用 术后 PACO2 

分 类 号：R726.5[医药卫生—儿科]