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目的探讨高频震荡通气(HFOV)在婴儿先天性心脏病(先心病)术后机械通气中的意义。方法研究对象为2003—2007年在上海交通大学医学院附属上海儿童医学中心收治的5例应用HFOV患儿,年龄为20d至7个月,平均(3.4±2.9)个月,体重3.3~10.0kg,平均(5.3±2.8)kg。记录呼吸机参数、心率(HR)、血压(BP)、中心静脉压(CVP)、正性肌力药物种类及用量、胸部X线平片表现、动脉血气分析变化情况及治疗措施,根据公式计算P/F比值(PaO2/FiO2ratio)、肺泡动脉氧分压阶差(A-aDO2)、呼吸指数(Respiratory Index,RI)。结果5例患儿在应用常频通气(CV)1.5~13h(7.4±5.0h)后开始应用HFOV,HFOV时间为15~52h,平均(31.4±15.1)h。4例在应用HFOV0.5~3h后临床表现和动脉血气分析好转,1例临床无明显好转。应用HFOV过程中均未出现血流动力学波动,HR、BP、CVP无明显变化(P>0.05),且不需要特别扩容或正性肌力药物的调整。5例中2例死亡,死亡原因为高钾血症致室颤和家属放弃治疗。结论对于肺部存在严重并发症的患儿,在呼吸功能改善上,HFOV表现出比CV更大的优势,应在严重的低氧血症、高碳酸血症、呼吸性酸中毒等对血流动力学、心功能甚至其它脏器功能造成不良影响之前尽早应用。
Objective To investigate the significance of high frequency oscillatory ventilation (HFOV) in mechanical ventilation after congenital heart disease (CHD) in infants. Methods The subjects were 5 HFOV children aged from 20d to 7 months (average, 3.4 ± 2.9) months and weight ranged from 3.3 to 10.0kg, who were admitted to Shanghai Children’s Medical Center affiliated to Shanghai Jiaotong University School of Medicine from 2003 to 2007. , Average (5.3 ± 2.8) kg. Recorded ventilator parameters, heart rate (HR), blood pressure (BP), central venous pressure (CVP), type and amount of inotrope, chest X-ray findings, arterial blood gas analysis changes and treatment measures, according to the formula P / F ratio (PaO2 / FiO2ratio), alveolar arterial oxygen pressure level difference (A-aDO2), respiratory index (Respiratory Index, RI). Results HFOV was started in 5 patients after 1.5 ~ 13h (7.4 ± 5.0h) of CV and the HFOV time was 15 ~ 52h with an average of (31.4 ± 15.1) h. 4 cases of HFOV0.5 ~ 3h after application of clinical manifestations and arterial blood gas analysis improved, 1 case no significant improvement in clinical. Hemodynamic fluctuations were not observed during the application of HFOV, HR, BP, CVP no significant change (P> 0.05), and does not require special expansion or inotropic drugs adjustment. Two of the five patients died, the cause of death being hyperkalemia-induced ventricular fibrillation and family abandonment. Conclusions In children with severe pulmonary complications, HFOV has a greater advantage than CV in improving respiratory function. Serious hypoxemia, hypercapnia, respiratory acidosis, Kinetics, cardiac function and even other adverse effects caused by organ function as soon as possible.