目的探讨高频振荡通气(HFOV)在小儿重度急性呼吸窘迫综合征(ARDS)合并气漏中的应用价值及安全性。 方法结合1例腺病毒感染致重度ARDS合并大量气胸患儿的临床资料及国内外相关文献, 评价早期HFOV在儿童重度ARDS综合治疗中的价值。 结果患儿机械通气前动脉血PaO2/FiO2为41 mm Hg, 氧合指数(OI)为35, 动脉血PaCO2为72 mm Hg, SaO2为10%。放置胸腔引流管, 约2 h换用HFOV, 在咪达唑仑、芬太尼基础上加用维库溴铵以保证人机的协调性。患儿气漏逐渐稳定吸收, PaO2/FiO2逐日升高, OI逐日下降, PaCO2维持在50~60 mm Hg。开始运用HFOV时患儿心率增快, 血压进行性下降, 经生理盐水、白蛋白扩容以及去甲肾上腺素、多巴胺升压后稳定。共使用HFOV治疗7 d, 常规频率机械通气2 d, 住院10 d后转出儿科重症监护室, 一共住院3周, 痊愈出院。 结论早期应用HFOV对改善大量气漏的重度ARDS患儿的通气和氧合有益, 但HFOV对血流动力学有影响
References
[1]
19. Yildizdas D, Yapicioglu H, Bayram I, et al.High-frequency oscillatory ventilation for acute respiratory distress syndrome.Indian J Pediatr, 2009, 76:921-927.
[2]
20. Luyt Cé, Combes A, Trouillet JL, et al.Virus-induced acute respiratory distress syndrome:epidemiology, management and outcome.Presse Med, 2011, 40:e561-e568.
[3]
21. Goh AY, Chan PW, Roziah M.Surfactant replacement therapy in RSV-induced acute respiratory distress syndrome (ARDS).Singapore Med J, 1999, 40:113-116.
[4]
22. Piastra M, Onesimo R, De Luca D, et al.Measles-induced respiratory distress, air-leak and ARDS.Eur J Clin Microbiol Infect Dis, 2010, 29:181-185.
[5]
23. Bhanthumkosol D.Fatal adenovirus infections in infants probably infected with HIV.J Med Assoc Thai, 1998, 81, 214-222.
[6]
24. Choi J, Kim YS, Kim MS, et al.Acute respiratory distress syndrome by cytomegalovirus infection in an immunocompetent infant.Pediatr Pulmonol, 2008, 43:824-827.
[7]
25. Rankin N, Day AC, Crone PD.Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation.Case report.J Trauma, 1994, 36:428-429.
[8]
26. Dodds CP, Hillman KM.Management of massive air leak with asynchronous independant lung ventilation.Intensive Care Med, 1982, 8:287-290.
[9]
27. Reiche-Fischel O, Helfrick JF.Intraoperative life-threatening emphysema associated with endotracheal intubation and air insufation devices:report of two cases.J Oral Maxillofac Surg, 1995, 53:1103-1107.
[10]
28. Shen HN, Lu FL, Wu HD, et al.Management of tension pneumatocele with high-frequency oscillatory ventilation.Chest, 2002, 121:284-286.
[11]
29. Markus-Rodden MM, Bojko T, Hauck LC.Traumatic tracheal laceration in a pediatric patient medically managed with high-frequency oscillatory ventilation.Pediatr Emerg Care, 2008, 24:236-237.
6. Marchak RH, Thompson WK, Duffy P, et al.Treatment of RDS by high frequency oscillatory ventilation:a preliminary report.J Pediatr, 1981, 99:287-292.
[20]
7. Gupta P, Green JW, Tang X, et al.Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.JAMA Pediatr, 2014, 168:243-249.
[21]
8. Arnold JH.High-frequency ventilation in the pediatric intensive care unit.Pediatr Crit Care Med, 2000, 1:93-99.
[22]
9. Faqih NA, Qabba'h SH, Rihani RS, et al.The use of high frequency oscillatory ventilation in a pediatric oncology intensive care unit.Pediatr Blood Cancer, 2012, 58:384-389.
[23]
10. Babbitt CJ, Cooper MC, Nussbaum E, et al.High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure:disease-specific morbidity survival analysis.Lung, 2012, 190:685-690.
[24]
11. Moniz M, Silvestre C, Nunes P, et al.High-frequency oscillatory ventilation in children:a 10-year experience. J Pediatr (Rio J), 2013, 89:48-55.
[25]
12. Martinón Torres F, Rodríguez Nú？ez A, Jaimovich DG, et al.High-frequency oscillatory ventilation in pediatric patients.Protocol and preliminary results.An Esp Pediatr, 2000, 53:305-313.
[26]
13. Clark RH, Gerstmann DR, Null DM Jr, et al.Prospective randomized comparison of high frequency oscillatory ventilation and conventional ventilation in respiratory distress syndrome.Pediatrics, 1992, 89:5-12.
[27]
14. Pinzon AD, Rocha TS, Ricachinevsky C, et al.High-frequency oscillatory ventilation in children with acute respiratory distress syndrome:experience of a pediatric intensive care unit.Rev Assoc Med Bras, 2013, 59:368-374.
[28]
15. Rowan CM, Cristea O, Greathouse ST, et al.Preemptive use of high-frequency oscillatory ventilation in pediatric burn patients.J Burn Care Res, 2013, 34, 237-242.
[29]
16. Fedora M, Klimovic M, Seda M, et al.Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome.Bratisl Lek Listy, 2000, 101:8-13.
[30]
17. Wang CC, Wu WL, Wu ET, et al.High frequency oscillatory ventilation in children:experience of a medical center in Taiwan.J Formos Med Assoc, 2008, 107:311-315.
[31]
18. Ben Jaballah N, Khaldi A, Mnif K, et al.High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.Pediatr Crit Care Med, 2006, 7:362-367.
