高频通气在肺抢救监护病房(PICU)中应用(附25例分析)

我们对PICU中25例危重患儿行高频通气(HFV)32例次(占同期机械通气病人的18.6％)。其中混合高频通气(CHFV)6例次,高频喷射通气(HFJV)10例次,高频正压通气(HFPPV)2例次,经鼻塞高频喷射给氧14例次。年龄范围:1天～10岁,主要原发病:重症肺炎伴呼衰、心衰,心肺复苏后,重症支气管哮喘,呼吸窘迫综合征等。经鼻气管内插管为高频通气主要途经。应用结果显示:经鼻塞高频给氧与普通给氧(口罩或头罩)相比,PaO_2和PaO_2/Fio2值明显上升(P<0.01),PaCO_2和PH无明显变化(P>0.05),混合高频通气组均无CO_2潴留,并提示其所需平均气道压(Paw)和吸气峰压值(PIP)较单纯常频通气时为低。本文对高频通气适应症、高频呼吸器参数的调节略加讨论。并指出:CO_2潴留和呼吸道湿化不足仍是高频喷射通气应用中存在的主要问题,为此可采取与常频通气交替使用,注意调节驱动力和频率等参数和加强气道管理等方法加以解决。

CLINICAL APPLICATION OF HIGH FREQUENCY VENTILATION IN PICU(ABSTRACT)

During the period of June, 1988-Jan, 1990, high frequency ventilation (HFV) was used 32 times, for the treatment of 25 critical patients which accounted for 18.6％ of patients treated with mechanical ventilation during the same period, The age of the 25 patients ranged from one day to ten years. The HFV that we used included combined high frequency ventilation (CHFV) for six times, high frequency jet ventilation (HFJV) for ten times, high frequency positive pressure ventilation (HFPPV) for two times, and high frequency jet oxygen inhalation (HFJOI) for 14 times. The route of HFV was intratracheal tube or nasal tube. The results of clinical application of the HFVS showed that there were significant difference in PaCO_2 and PaO_2/FiO_2 (P<0.01) between HFJOI and conventional oxygen inhalation; PaCO_2 and PH had no obvious change (P>0.05). Since CHFV improved the imparied gas exchang in lung, the mean airway pressure and peak inspiratory pressure required to maitain an adquate lung volume in CHFV appeared to be lowered than those in conventional mechanical ventilation (CMV), and there was no CO_2 retention. The paper also discussed the indication for HFV, selection of parameters for ventilator. It is pointed out that CO_2 retention and inadequate humidification are still major problems in HFV. To avoid such inadequecy, alternative use of HFV and CMV, careful adjustment of driving pressure and frequency, and improved managemant of airway are recommened.