高频振动通气在急性呼吸窘迫综合征治疗中的作用

目的　评估高频振动通气 (high frequencypercussiveventilation ,HFPV)在成人ARDS治疗中的有效性和安全性 ,探索ARDS治疗的新途径。方法　临床观察 93例ICU条件下使用HFPV的ARDS病人 ,对常规通气 (conventionalventilation ,CV)和HFPV下的PaO2 /FiO2 、PaCO2 、DO2 、VO2 、Qs/Qt、PEEP/CPAP、PAWP等氧代谢、血流动力学指标和呼吸参数的变化进行统计分析。结果　 93例病人中 ,存活 6 6例 ,死亡2 7例 ,死亡率为 2 9 0 % (除外 7例未死于ICU者 ,实际死亡率为 2 1 5 % )。使用HFPV前后PaO2 /FiO2 、PaC O2 、DO2 、VO2 、Qs/Qt的变化为 (77 6± 2 0 0 )和 (2 0 8 7± 70 8)、 (471 2± 114 7)和 (6 0 1 3± 14 0 9)、(10 7 6± 34 3)和 (14 6 4± 2 3 3)、 (35 7± 2 0 5 )和 (2 4 5± 6 5 ) (P <0 0 5 )。X ray胸片双肺阴影减轻或消失 ,同时可看到病人鼻腔口腔有不等量的混浊液体从呼吸道溢出。结论　HFPV在ARDS治疗中是有效和安全的。临床应用HFPV能明显改善氧代谢 ,提高PaO2 /FIO2 。早期应用和合理化管理能明显降低ARDS的病死率

The effect of high-frequency percussive ventilation on adults with ARDS

Objective To evaluate the safety and efficacy of high frequency percussive ventilation(HFPV)on adult patients with acute respiratory distress syndrome(ARDS),and to explore the new treatment for ARDS.Methods 93 patients with ARDS were observed in SICU.All patients were intubated and ventilated with HFPV.PaO 2/FiO 2,PaCO 2,DO 2,VO 2,Qs/Qt,PEEP/CPAP and PAWP were measured in conventional ventilation(CV) model at 8 hour,24hours,2 day after HFPV.Results HFPV demonstrated significant improvement in PaO 2/FiO 2,PaCO 2,DO 2,VO 2,PtCO 2/FiO 2,compared with CV.27 died among 93 patients.The mortality was 29.0%.Except 7 cases who didn't die in ICU,the actual mortality was 21.5%.Conclusion HFPV is a safe and effective method in treatment of ARDS,which can improve oxygen metabolism and reduce mortality.