高频振荡通气治疗新生儿气胸的监测与护理

总结了45例新生儿气胸应用高频振荡通气（ HFOV）治疗的监护经验。 HFOV期间通过对血流动力学的监护维持正常的血压、心率、血氧饱和度;通过对X线胸片和胸壁振动的监测避免肺过度膨胀;通过对血气和头颅B超的监测降低了颅内出血的发生。认为高频振荡通气治疗新生儿气漏时进行持续监测并加上规范的呼吸道管理,可避免各种并发症的发生,值得临床推广运用。     

高频振荡通气联合胸腔闭式引流治疗新生儿气胸的临床分析

目的总结高频振荡通气(HFOV)联合胸腔闭式引流治疗新生儿气胸的效果及临床分析。方法对35例使用HFOV联合胸腔闭式引流治疗的新生儿气胸患儿的病例进行回顾性的总结,记录HFOV使用前(0h)和使用后2、6、24、48h的动脉血气分析,同时记录采集血气时的吸入氧分数(FiO_2)。结果 35例气胸患儿经胸腔闭式引流及HFOV治疗2h时动脉血气中PaO_2明显上升,PaCO_2明显下降,与治疗开始时对比差异均有统计学意义(P0.05)。治疗6h时,动脉血乳酸较治疗开始时明显下降;24h时FiO_2的明显下降,血气pH值明显上升,与治疗开始时比较,差异有统计学意义(P0.05)。35例患儿中,29例患儿痊愈出院,治愈率82.9%,4例放弃治疗自动出院,2例死亡。结论胸腔闭式引流与HFOV是治疗新生儿气胸的主要手段,且安全、有效。     

高频震荡通气治疗新生儿呼吸衰竭合并气胸的疗效观察

新生儿呼吸衰竭合并气胸是新生儿ICU常见的严重急性疾患,多需机槭通气治疗,高频震荡机械通气(HFOV)是一种以小于或等于解剖死腔的潮气量,高的通气频率,在较低的气道压力下进行通气的一种特殊的通气方法,已被广泛的应用于临床.本科引进斯蒂芬尼呼吸机后,2010年6月至2011年1月,已经抢救成功10新生儿呼吸衰竭合并气胸的患儿.现作一回顾性分析,旨在探讨HFOV在治疗新生儿呼吸衰竭合并气胸的疗效.     

高频振荡通气治疗新生儿呼吸衰竭的疗效观察及护理体会

目的探讨高频振荡通气（HFOV）治疗新生儿呼吸衰竭的疗效及护理方法.方法回顾分析14例新生儿呼吸衰竭病例,分别记录HFOV开始时、8～12 h、24～48 h、48 h后患儿FiO2、PaO2、PaCO2、pH值.结果14例中痊愈10例,治愈率达71.43%;死亡2例,放弃治疗2例,共占28.57%.治疗8～12 h后,肺氧合状况开始改善.结论HFOV治疗新生儿呼吸衰竭是一种疗效肯定、安全性好的新型机械通气方法.护理过程中,呼吸气道的管理和呼吸机参数的调整是治疗关键.     

应用高频振荡通气抢救新生儿气胸成功一例

1临床资料患儿女,2 h。因窒息后面色青紫1 h余于2005年6月24日18:50入院。患儿系G2P2,胎龄41周,在当地医院分娩,头位阴道产,顺产。患儿娩出时面色青紫,不哭,无自主呼吸,心率60次/min,经人工呼吸,胸外按压,应用肾上腺素、纳洛酮及5%碳酸氢钠等抢救10 min,心率升至140次/min,但一直无自主呼吸,面色仍青紫,故急转送我院。入院查体:血压测不出,全身皮肤青紫,无自主呼吸。前囟平软,双瞳孔散大,固定,对光反射消失。心率10次/min,腹平软,肝肋下2.5 cm,四肢肌张力低下,觅食反射及吸吮反射消失。入院诊断:(1)新生儿肺炎并呼吸衰竭;(2)新生儿气胸;(3)…     

高频振荡通气治疗新生儿呼吸衰竭临床分析

目的探讨高频振荡通气(HFOV)治疗新生儿呼吸衰竭的疗效。方法 98例新生儿呼吸衰竭病儿分为常规辅助通气(CMV)组48例,HFOV组50例,观察2组血气改善情况。结果 2组上机前血气观察指标比较无统计学差异(P均>0.05);2组上机2h和24h与上机前的血气观察指标明显改善(P均<0.05),且HFOV组显著优于CMV组(P<0.05)。结论 HFOV组在改善肺功能,促进肺通气和肺换气,显著优于CMV组,是一种临床效果显著、安全性良好新型机械通气方法。     

高频振荡通气治疗新生儿重症呼吸衰竭

目的　探讨高频振荡通气 (HFV)治疗重症呼吸衰竭的疗效。方法　 1 3例重症呼吸衰竭新生儿 ,平均胎龄 33± 4周 ,体重 1 93± 0 85kg ,RDS 9例 ,先天性膈疝 4例 ,经常规机械通气 (CMV)治疗失败后改为HFV治疗 ,治疗过程中监测心率、血压、动脉血气及氧合指数等。结果　 1 3例患儿用HFV后 2h动脉血氧饱和度 (SaO2 )均≥ 0 90 ;在实施HFV治疗 8h后 ,平均气道压 (MAP)由 0 1 6 5± 0 0 38kPa降至 0 1 0 5± 0 0 4 6kPa(q =4 0 3,P <0 0 1 ) ;动脉肺泡氧分压 (a/A)由 (0 0 8± 0 0 2 )升至 (0 2 4± 0 1 1 )q=8 35 ,P <0 0 1 ) ,氧合指数 (OI)由 (30± 1 3)降至 (1 0± 4 ) (q =8 1 6 ,P <0 0 1 ) ;所需氧浓度 (FiO2 )亦由 (0 90± 0 1 0 )显著降至 (0 6 2± 0 1 7) (q =3 37,P <0 0 5 )。结论　重症呼吸衰竭用CMV无效后改用HFV可获得显著疗效 ,表现为氧合改善快、短时间内FiO2 迅速降低     

高频振荡通气治疗新生儿呼吸衰竭的疗效观察及护理体会

目的探讨高频振荡通气(HFOV)治疗新生儿呼吸衰竭的疗效及护理方法.方法回顾分析14例新生儿呼吸衰竭病例,分别记录HFOV开始时、8～12 h、24～48 h、48 h后患儿FiO2、PaO2、PaCO2、pH值.结果14例中痊愈10例,治愈率达71.43%;死亡2例,放弃治疗2例,共占28.57%.治疗8～12 h后,肺氧合状况开始改善.结论HFOV治疗新生儿呼吸衰竭是一种疗效肯定、安全性好的新型机械通气方法.护理过程中,呼吸气道的管理和呼吸机参数的调整是治疗关键.     

高频振荡通气治疗新生儿危重症的护理

总结应用高频振荡通气治疗32例新生儿危重症的护理。认为护理重点是加强呼吸道管理，注意气体温湿化及适时吸痰，预防呼吸道感染，密切观察氧饱和度，做好循环系统监护。经治疗及护理，22例痊愈出院，6例放弃治疗，4例死亡。     

高频振荡通气治疗新生儿肺出血的护理

新生儿肺出血是指肺大量出血,至少影响2个肺叶[1]。常发生在许多疾病的晚期,是新生儿死亡的重要原因之一。机械通气是治疗新生儿肺出血的主要手段。以往常频通气(conventional mechanical ventilation CMV)在一定程度上降低了病死率,但是往往存在低通气压力不能改善肺血氧合状况,高通气压力又易导致肺组织气压伤的矛盾[2]。近年来,低潮气量的高频通气作为一种肺保护策略,开始     

高频振荡通气治疗新生儿持续肺动脉高压

目的回顾性分析高频振荡通气(HFOV)治疗新生儿持续肺动脉高压(PPHN)的疗效。方法对2010年1月至2014年6月连云港市第一人民医院NICU收治的25例PPHN患儿进行高频振荡通气,观察其治疗前后血气指标的变化及临床疗效。结果 25例患儿中1例死亡,2例放弃治疗,其余全部治愈。治疗后12 h通气氧合明显改善,二氧化碳分压(PCO2)由(75.35±10.20)mm Hg(1 mm Hg=0.133 k Pa)下降至(60.38±9.20)mm Hg,氧分压(PO2)由(38.75±8.20)mm Hg上升至(56.70±5.30)mm Hg,差异有统计学意义(P0.01);治疗后24 h气道压力(Paw)明显下降,吸入氧浓度(Fi O2)明显降低,差异有统计学意义(P0.01);治疗后肺动脉压力由(58.26±12.15)mm Hg下降至(24.43±13.78)mm Hg,差异有统计学意义(P0.05)。结论 HFOV治疗PPHN效果好,在无NO吸入治疗的情况下可作为首选治疗方法。     

常频通气联合高频振荡通气治疗新生儿呼吸衰竭68例疗效分析

目的探讨常频通气联合高频振荡通气治疗新生儿呼吸衰竭的临床效果。方法将收治的68例新生儿呼吸衰竭患者,随机分为对照组和观察组。两组均给予抗感染、血管活性药物、保护各脏器功能等营养支持治疗。对照组在此基础上采用常频机械通气治疗。观察组在此基础上采用常频通气联合高频振荡通气治疗。分析两组治疗效果及不良反应发生情况。结果两组经治疗后平均动脉压、心率较治疗前未见明显变化(P>0.05)。对照组总有效率为70.6%,观察组总有效率为91.2%。两组总有效率差异有统计学意义(P<0.05)。两组氧分压(PaO2)、二氧化碳分压(PaCO2)氧合指标与治疗前相比差异有显著性(P<0.05)。观察组治疗后PaO2与对照组相比显著上升,PaCO2与对照组相比显著下降,两组差异有显著性(P<0.05)。结论高频通气联合常频通气治疗新生儿呼吸衰竭疗效优于单用常频机械通气,对平均动脉压、心率影响小,使用方便,值得临床推广应用。     

常频叠加高频振荡通气对肺损伤大鼠氧合及通气的影响

目的观察常频叠加高频振荡通气对急性肺损伤大鼠氧合和通气的影响。方法以15只Wistar大鼠为实验对象,给予机械通气,用生理盐水肺灌洗制作急性肺损伤大鼠模型,先后行常频机械通气(CMV参数:FiO2 100%、f 30 bpm、PEEP 6 cmH2O、I∶E 1∶2、MAP 12 cmH2O)、高频振荡通气(HFOV参数:FiO2 100%、f 11 Hz、Paw 12 cmH2O、Ti 33%)、常频叠加高频振荡通气(CMV+HFOV参数同前)各1 h,监测动脉血气。计算PaO2/FiO2、氧合指数(OI)、肺内血分流率(Qs/Qt)。结果损伤前、CMV、HFOV、CMV+HFOV各指标变化:(1)PaCO2分别为(41.04±3.94)mmHg、(100.5±28.73)mmHg、(82.06±22.87)mmHg及(54.01±19.32)mmHg,损伤后均显著高于损伤前(P<0.01);CMV+HFOV显著低于CMV、HFOV(P<0.01);CMV、HFOV两者差异无统计学意义(P>0.05)。(2)PaO2/FiO2分别为(467.9±47.71)mmHg、(105.3±25.39)mmHg、(131.2±67.72)mmHg、(216.3±76.84)mmHg,损伤后均显著低于损伤前(P<0.01);CMV+HFOV显著高于CMV、HFOV(P<0.01);CMV、HFOV两者差异无统计学意义(P>0.05)。(3)OI分别为1.88±0.30、8.84±2.15、6.16±3.19、4.60±1.71,损伤后均显著高于损伤前(P<0.01);CMV+HFOV、HFOV显著低于CMV(P<0.01);CMV+HFOV、HFOV两者差异无统计学意义(P>0.05)。(4)Qs/Qt分别为0.11±0.02、0.29±0.02、0.26±0.05及0.24±0.04,损伤后显著高于损伤前(P<0.01);各通气模式差异无统计学意义(P>0.05)。结论常频叠加高频振荡通气在促进肺损伤大鼠CO2排出及改善氧合方面优于单纯常频通气和单纯高频通气。     

高频振荡通气治疗重症新生儿呼吸窘迫综合征的临床研究

目的观察高频振荡通气(HFOV)治疗重症新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法 40例重症NRDS早产儿按通气模式分为研究组(HFOV+SIMV模式)20例和对照组(SIMV或A/C模式)20例,比较两组患儿上机后1h、12h和24h血气变化、上机时间以及气胸、颅内出血等并发症的发生率。结果研究组上机后1h与对照组比较,血氧分压明显上升,差异有统计学意义(t=3.83,P<0.05),二氧化碳分压显著下降,差异有统计学意义(t=2.09,P<0.05)。上机后12h、24h的血氧分压、二氧化碳分压与对照组比较,差异无统计学意义(t分别=1.03、0.23;0.33、0.55,P均>0.05)。研究组上机时间短于对照组,差异有统计学意义(t=3.37,P<0.05);气胸发生率低于对照组(χ2=4.32,P<0.05),颅内出血的发生率两组差异无统计学意义(χ2=0.43,P>0.05)。结论 HFOV是一种安全性好、疗效肯定的治疗早产儿重症NRDS的机械通气方法。     

高频震荡通气治疗吸入性肺损伤的作用

目的探讨治疗吸入性肺损伤合并急性呼吸衰竭的呼吸支持手段。方法按第三军医大学的方法,利用新西兰大白兔,制造兔重度蒸汽吸入性损伤并呼吸衰竭模型,用CMV、HFOV方法进行通气治疗,分别在伤后1、2、3、4 h,抽股动脉血检测血气;4 h后处死,取兔右肺下叶称重后,计算干湿重比;右肺中叶4个不同部位(依赖区和非依赖区)取标本,做病理检查。结果①HFOV组和CMV组PaO_2均在伤后1 h明显上升,伤后4 h内动脉血仍有良好氧合,自伤后2 h点动脉血氧合和PO_2a/A,HFOV组明显优于CMV组,差异具有统计学意义(P＜0．01);P_((A-n))O_2在2 h和4 h点,CMV组明显高于HFOV组(P＜0．05);PaCO_2在各时相点均差异无统计学意义(P＞0．05)。②兔肺湿干重比两组差异无统计学意义(P＞0．05)。③组织学损伤HFOV组较CMV明显减轻(P＜0．05)。结论高频震荡通气能显著提高蒸汽吸入性损伤兔的动脉血氧合,减轻兔肺的损伤,是治疗蒸汽吸入致急性呼吸衰竭的良好通气模式。     

高频震荡通气治疗新生儿肺透明膜病

目的：评价高频振荡通气治疗新生儿肺透明膜病的疗效。方法：将32例新生儿呼吸窘迫综合征患儿分成两组，16例采用高频振荡通气治疗，16例常规机械通气治疗；观察两组患儿的肺功能及并发症。结果：高频振荡通气组患儿在治疗后6，12，24h，氧浓度、氧合指数明显下降并低于机械通气组，动脉／肺泡氧分压比值明显上升并高于机械通气组，有显著性差异（P〈0．05或0．01）。高频振荡通气组并发症和病死率低于机械通气组，存活的患儿的上机时间、氧疗时间、住院时间比机械通气组短，差异有显著性（P〈0．05或0．01）。结论：高频振荡通气能更好改善肺透明膜病患儿的肺氧合功能，减少并发症，缩短病程，降低病死率，对治疗具有很好的疗效。     

High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

OBJECTIVE: To describe the time course of high frequency oscillatory ventilation (HFOV) in respiratory syncytial virus (RSV) bronchiolitis. DESIGN: Retrospective charts review. SETTING: A tertiary paediatric intensive care unit. PATIENTS AND PARTICIPANTS: Infants with respiratory failure due to RSV infection. INTERVENTION: HFOV. MEASUREMENTS AND RESULTS: Pattern of lung disease, ventilatory settings, blood gases, infant's vital parameters, sedation and analgesia during the periods of conventional mechanical ventilation (CMV, 6 infants), after initiation of HFOV (HFOVi, 9 infants), in the middle of its course (HFOVm), at the end (HFOVe) and after extubation (Post-Extub) were compared. All infants showed a predominant overexpanded lung pattern. Mean airway pressure was raised from a mean (SD) 12.5 (2.0) during CMV to 18.9 (2.7) cmH(2)O during HFOVi (P < 0.05), then decreased to 11.1(1.3) at HFOVe (P < 0.05). Mean FiO(2) was reduced from 0.68 (0.18) (CMV) to 0.59 (0.14) (HFOVi) then to 0.29 (0.06) (P < 0.05) at HFOVe and mean peak to peak pressure from 44.9 (12.4) cmH(2)O (HFOVi) to 21.1 (7.7) P < 0.05 (HFOVe) while mean (SD) PaCO(2) showed a trend to decrease from 72 (22) (CMV) to 47 (8) mmHg (HFVOe) and mean infants respiratory rate a trend to increase from 20 (11) (HFOVi) to 34 (14) (HFOVe) breaths/min. With usual doses of sedatives and opiates, no infant was paralysed and all were extubated to CPAP or supplemental oxygen after a mean of 120 h. CONCLUSION: RSV induced respiratory failure with hypercapnia can be managed with HFOV using high mean airway pressure and large pressure swings while preserving spontaneous breathing.     

Considerations of single-lung ventilation in neonatal thoracoscopic surgery with cardiac arrest caused by bilateral pneumothorax: A case report

BACKGROUNDTension pneumothorax of the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax. If not rapidly diagnosed and managed, this condition can lead to sudden death. We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARYWe report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax. The patient suffered sudden cardiac arrest and received emergency treatment to revive her. The recognition of dangerous vital sign parameters, rapid evacuation of the artificial pneumothorax, and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important. Moreover, even though the sinus rhythm was restored, the patient’s continued tachycardia, reduced pulse pressure, and depressed pulse oximeter waveform were worrisome. We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls. Sometimes thoracoscopy can be used for rapid examination; if the mediastinum is observed to be shifted to the right, it may indicate tension pneumothorax. This condition can be immediately relieved by needle thoracentesis, ultimately allowing the safe completion of the surgical procedure.CONCLUSIONBilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery. Therefore, anesthesiologists should consider this possibility, be alert, and address this rare but critical complication in a timely manner.     

A prospective randomized comparison of conventional mechanical ventilation and very early high frequency oscillatory ventilation in extremely premature newborns with respiratory distress syndrome

Objective: To compare the effectiveness and safety of very early high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) in treatment of the respiratory distress syndrome (RDS) and to evaluate their impact on the incidence of chronic pulmonary disease and early and late morbidity of very low-birthweight neonates. Design: A prospective randomized clinical trial. Setting: Tertiary neonatal intensive care unit in the Perinatology Center in Prague. Patients: 43 premature newborns, delivered in the Department of Obstetrics in the Perinatology Center, were randomly divided into two groups (HFOV and CMV) immediately after delivery; 2 patients in each group died, 2 fulfilled crossover criteria from CMV to HFOV, and 2 were excluded because of congenital malformations. Nineteen patients treated with HFOV were therefore compared with 18 infants in the CMV group. Methods: The two contrasting modes of ventilation were introduced immediately after intubation. Maintenance of optimal lung volume in HFOV to optimize oxygenation and the therapeutic administration of surfactant after fulfilling defined criteria are important points of the strategy and design of the study. Measurements and main results: Except for a higher proportion of males in the HFOV group (p < 0.02), the basic clinical characteristics (gestational age, birthweight, Apgar score at 5 min, umbilical arterial pH), the two groups were similar. In the acute stage of RDS, infants treated with HFOV had higher proximal airway distending pressure with HFOV for 6 h after delivery (p < 0.05). For a period of 12 h after delivery lower values for the alveolar-arterial oxygen difference (p < 0.03) were noted. The number of patients who did not require surfactant treatment was higher in the HFOV group (11 vs 1, p < 0.001). In the HFOV group the authors found a lower roentgenographic score at 30 days of age (p < 0.03) and a lower clinical score in the 36th postconceptional week (p < 0.05), using these two scoring systems for assessing chronic lung disease according to Toce scale. The incidence of pneumothorax, pulmonary interstitial emphysema, intraventricular hemorrhage and retinopathy of prematurity in both groups was the same. Conclusions: HFOV, when applied early and when the clinical strategy of maintenance of optimal lung volume is used, improves oxygenation in the acute stage of RDS, reduces the need of surfactant administration, and can decrease the injury to lung tissue even in extremely immature newborns to whom surfactant is administered therapeutically. Received: 3 December 1997 Final revision received: 31 August 1998 Accepted: 1 September 1998     

高频振荡通气治疗新生儿重症肺透明膜病的护理

总结11例重症新生儿肺透明膜病应用高频振荡通气治疗期间的护理体会，认为密切的临床监护，掌握适宜的气道管理技术，重点掌握完善的气道加温湿化及正确的吸痰时间和方法，预防感染及其他主要并发症的观察和护理，是有效降低并发症，提高抢救成功率及生存质量的重要环节。