高频振荡通气与常规机械通气治疗儿童急性呼吸窘迫综合征:单中心前瞻性随机对照研究  

Application of high frequency oscillatory ventilation and conventional mechanical ventilation in the treatment of pediatric acute respiratory distress syndrome:a single-center prospective randomized controlled study

作　　者：张瑾[1] 曲东[1] 任晓旭[1] 那巍兰 刘霜[1] 黄偲元 Zhang Jin;Qu Dong;Ren Xiaoxu;Na Weilan;Liu Shuang;Huang Siyuan(Department of Critical Medicine,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院重症医学科,北京100020

出　　处：《中华实用儿科临床杂志》2025年第1期44-49,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费(XTCX201820)。

摘　　要：目的比较高频振荡通气(HFOV)与常规机械通气(CMV)治疗儿童急性呼吸窘迫综合征(ARDS)的临床效果。方法前瞻性随机对照研究。观察2017年1月至2018年12月首都儿科研究所附属儿童医院重症监护室(ICU)进行机械通气治疗的ARDS患儿,随机(计算机数字法)分为HFOV组与CMV组。记录2组患儿基本资料、小儿危重评分、氧合指数(OI)、血气、机械通气时间、呼吸机参数、ICU住院时间、并发症发生情况、预后、炎症因子动态变化、镇静肌松药及血管活性药物使用情况等临床指标。应用SPSS 22.0软件对数据进行分析,计量资料比较采用Mann Whitney U检验,计数资料比较采用χ^(2)检验。结果共45例患儿纳入分析,其中HFOV组21例,CMV组24例;中重度ARDS共34例,其中HFOV组16例,CMV组18例。24 h、48 h HFOV组OI较CMV组均显著降低,分别为[7.4(5.9,8.6)比9.0(6.7,13.6),P=0.018]和[5.9(5.2,8.5)比9.2(7.4,12.4),P=0.001]。中重度ARDS患儿中,通气6 h开始,HFOV组OI较CMV组即显著降低[OI-6 h:8.2(6.5,10.0)比10.5(8.2,13.0),P=0.037;OI-12 h:7.8(6.5,9.0)比9.8(8.0,12.8),P=0.009;OI-24 h:7.7(6.4,8.6)比10.1(8.7,15.5),P<0.001;OI-48 h:6.0(5.3,8.6)比10.7(8.8,13.1),P<0.001;OI-72 h:5.8(5.0,8.6)比8.0(6.6,10.6),P=0.031],差异均有统计学意义。CMV组与HFOV组患儿ICU住院时间、有创机械通气时间、总机械通气时间、28 d预后、血管活性药物、肌松药物使用、血液净化使用、液量平衡、炎症因子、颅内出血、气胸并发症情况比较差异均无统计学意义(均P>0.05)。结论HFOV较CMV可更快改善ARDS患儿氧合水平,且中重度ARDS患儿更早获益。HFOV较CMV未增加气胸、颅内出血等并发症的发生,血管活性药和肌松药物的使用无增加,临床应用安全。ObjectiveTo compare the effect of high frequency oscillatory ventilation(HFOV)and conventional mechanical ventilation(CMV)in the treatment of pediatric acute respiratory distress syndrome(ARDS).MethodsA prospective randomized controlled study was conducted on ARDS children treated with mechanical ventilation in the Intensive Care Unit(ICU)of Children′s Hospital,Capital Institute of Pediatric from January 2017 to December 2018.They were randomly(computer digital method)divided into HFOV group and CMV group.The basic data and clinical indicators,such as pediatric critical illness scores,oxygenation index(OI),blood gas,mechanical ventilation time,ventilator parameters,ICU hospitalization time,complications,prognosis,dynamic changes of inflammatory factors,use of sedative muscle relaxants and vasoactive drugs,were recorded.SPSS 22.0 software was used to analyze the data.The Mann Whitney U test was used for inter-group comparison.Theχ^(2) test was adopted for the comparison of counting data.ResultsA total of 45 children were included in the analysis.There were 21 cases in the HFOV group and 24 cases in the CMV group.Moderate and severe ARDS was detected in 34 cases,including 16 cases in the HFOV group and 18 cases in the CMV group.Compared with those in the CMV group,the levels of OI-24 h and OI-48 h in the HFOV group were significantly lower[7.4(5.9,8.6)vs.9.0(6.7,13.6),P=0.018]and[5.9(5.2,8.5)vs.9.2(7.4,12.4),P=0.001].The levels of OI-6 h[8.2(6.5,10.0)vs.10.5(8.2,13.0),P=0.037],OI-12 h[7.8(6.5,9.0)vs.9.8(8.0,12.8),P=0.009],OI-24 h[7.7(6.4,8.6)vs.10.1(8.7,15.5),P<0.001],OI-48 h[6.0(5.3,8.6)vs.10.7(8.8,13.1),P<0.001]and OI-72 h[5.8(5.0,8.6)vs.8.0(6.6,10.6),P=0.031]in children with moderate to severe ARDS of the HFOV group were significantly lower than those of the CMV group.There were no significant differences in ICU hospitalization time,invasive mechanical ventilation time,total mechanical ventilation time,28-day prognosis,vasoactive drugs,muscle relaxants,blood purification,fluid balance,inflammatory factors,int

关 键 词：高频振荡通气 急性呼吸窘迫综合征 常规机械通气 儿童 

分 类 号：R725.6[医药卫生—儿科]