CAJ | 학술논문

目的：研究常频叠加呼气相高频通气模式在先天性心脏病术后合并重度呼吸窘迫综合征婴幼儿的应用效果。方法2012年1月至2013年8月,13例患儿,年龄(8.15±4.34)个月,体重(8.23±4.01)kg,应用常频叠加呼气相高频通气。原常频条件不变,呼气相高频振幅25~35 A,频率7~9 Hz。按高频前30 min 时患儿氧合指数(oxygenation index,OI,OI ﹦MAP ×FiO2/PaO2)分成2组, OI≤20为高 OI 组(n ﹦5)和 OI 〈20为低 OI 组(n ﹦8),观察两组患儿叠加高频后2、6、24、48 h 的 OI、PaO2/FiO2、PaCO2。结果全组应用高频前 OI 为19.31±4.42,应用后2 h、6 h、24 h、48 h,OI 分别降低至18.77±5.18、16.00±5.22、14.77±6.56和13.92±6.53(P 〈0.01)；PaCO2从(43.46±5.67)mmHg (1 mmHg ﹦0.133 kPa)降低至(38.31±4.21)mmHg、(37.61±3.36)mmHg、(34.77±3.81)mmHg 和(35.92±2.39)mmHg(P 〈0.01)。高 OI 组5例患儿,应用高频前后 OI 无显著差异,3例死亡患儿均为高 OI 组。结论先天性心脏病婴幼儿术后合并重度急性呼吸窘迫综合征病死率高。应用常频叠加呼气相高频可能改善氧合,降低二氧化碳分压,OI 〈20时,效果较好。
목적：연구상빈첩가호기상고빈통기모식재선천성심장병술후합병중도호흡군박종합정영유인적응용효과。방법2012년1월지2013년8월,13례환인,년령(8.15±4.34)개월,체중(8.23±4.01)kg,응용상빈첩가호기상고빈통기。원상빈조건불변,호기상고빈진폭25~35 A,빈솔7~9 Hz。안고빈전30 min 시환인양합지수(oxygenation index,OI,OI ﹦MAP ×FiO2/PaO2)분성2조, OI≤20위고 OI 조(n ﹦5)화 OI 〈20위저 OI 조(n ﹦8),관찰량조환인첩가고빈후2、6、24、48 h 적 OI、PaO2/FiO2、PaCO2。결과전조응용고빈전 OI 위19.31±4.42,응용후2 h、6 h、24 h、48 h,OI 분별강저지18.77±5.18、16.00±5.22、14.77±6.56화13.92±6.53(P 〈0.01)；PaCO2종(43.46±5.67)mmHg (1 mmHg ﹦0.133 kPa)강저지(38.31±4.21)mmHg、(37.61±3.36)mmHg、(34.77±3.81)mmHg 화(35.92±2.39)mmHg(P 〈0.01)。고 OI 조5례환인,응용고빈전후 OI 무현저차이,3례사망환인균위고 OI 조。결론선천성심장병영유인술후합병중도급성호흡군박종합정병사솔고。응용상빈첩가호기상고빈가능개선양합,강저이양화탄분압,OI 〈20시,효과교호。
Objective Some children with congenital heart defect would get serious acute respiratory distress syndrome in ICU postoperatively,which is a tough problem.We summarized the clinical effects of synchronized intermittent mandatory ventilation (SIMV)with expiratory high frequency ventilation (HFV) for these patients in our center.Methods A total of 13 pediatric patients,with(8.15 ±4.34)months old and (8.23 ±4.01 )kg weight,used SIMV with expiratory HFV from Jan 2012 to Aug 2013.Keeping the original SIMV conditions unchanged,the expiratory oscillation amplitude were 25 to 35 Ann(A)and the oscillation frequency of 7 to 9 hertz(Hz).All patients were divided into two groups to oxygenation index(OI)30 min before HFV,high OI group(OI≤20,n ﹦5)and low OI group(OI 〈20,n ﹦8).OI ﹦MAP ×FiO2 /PaO2 .The values of OI,PaO2 /FiO2 and PaCO2 of two groups were monitored before and at 2,6,24,48 h after HFV re-spectively.Results The values of OI of all 13 patients were 19.31 ±4.42 before HFV,and then decreased to 18.77 ±5.18,16.00 ±5.22,14.77 ±6.56,and 13.92 ±6.53 respectively at 2,6,24 and 48 hours later (P 〈0.01 ).But there was no significant difference of OI in high OI group in different time points.The val-ues of PaCO2 of all 13 patients were(43.46 ±5.67)mmHg(1 mmHg ﹦0.133 kPa)before HFV,and de-creased to(38.31 ±4.21)mmHg,(37.61 ±3.36)mmHg,(34.77 ±3.81 )mmHg,and(35.92 ±2.39)mmHg respectively at 2,6,24,and 48 hours after HFV(P 〈0.01 ).Three dead patients were all in high OI group. Conclusion The mortality rate of serious acute respiratory distress syndrome with congenital heart diseases postoperatively is high.SIMV with expiratory HFV can improve oxygenation and reduce carbon dioxide,and the effect is better when OI 〈20.