高频振荡机械通气治疗儿童麻疹肺炎合并重度急性呼吸窘迫综合征临床研究

摘要

目的 探讨高频振荡通气治疗儿童麻疹肺炎合并重度急性呼吸窘迫综合征的疗效及安全性.方法 将2012年10月至2015年1月河北省儿童医院PICU收治的麻疹肺炎合并重度急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患儿63例,随机分为常频机械通气(conventional mechanical ventilation,CMV)组和高频振荡通气(high-frequency oscillatory ventilation,HFOV)组.监测两组患儿治疗前及治疗后12h、24 h、48 h氧合指数(PaO2/FiO2、OI),记录心率、平均动脉压,同时记录气漏发生例数,统计病死率.评价HFOV在儿童麻疹重症肺炎合并重度ARDS中的疗效及安全性.结果 HFOV治疗后12h,PaO2/FiO2明显升高,OI明显减低,并且可以维持至48 h,与CMV组比较氧合指数改善更显著,差异具有统计学意义.HFOV组平均通气时间较CMV组缩短[(7.97 ±3.06)d vs.(11.03±3.60)d],但差异无统计学意义(P＞0.05).两组治疗后48 h心率逐渐恢复正常,组间比较差异无统计学意义(P＞0.05).两组治疗前与治疗后各时间段MAP比较,差异均无统计学意义.CMV组与HFOV组气漏发生率分别为24.2％、16.7％,差异无统计学意义.CMV组与HFOV组病死率分别为45.5％、33.3％,差异无统计学意义.结论 儿童麻疹肺炎并发重度ARDS早期给予HFOV治疗,能够有效改善氧合,亦不增加气漏并发症的发生,对血流动力学无不良影响.儿童麻疹肺炎并发重度ARDS早期给予HFOV治疗有效和安全性良好.%Objective To explore the effectiveness and safety of high frequency oscillatory ventilation(HFOV) in children with measles complicated with severe pneumonia and the acute respiratory distress syndrome(ARDS).Methods A total of 63 children with measles complicated with severe pneumonia and the ARDS were divided into conventional mechanical ventilation(CMV) group and HFOV group.The PaO2/ FiO2,oxygenation index (OI),HR and mean arterial pressure (MAP) before treatment and 12 h,24 h,48 h after treatment were detected.The rate of air leak and the motality in two groups were compared.The efficacy and safety of HFOV treatment were evaluated in children with measles complicated with pneumonia and severe ARDS.Results In HFOV group,the PaO2/FiO2 ratio was elevated and OI was decreased significantly after 12 h and maintained for at least 48 h.Compared with CMV group,OI of HFOV group improved more significantly,and the difference was statistically significant.The ventilation time in HFOV group was shorten than that in CMV group[(7.97 ±3.06) d vs.(11.03 ±3.60) d],but there was no statistical difference between two groups (P ＞ 0.05).The heart rate after treatment 48 h was gradually returned to normal,and there was no statistical difference between the two groups.There were no significant changes in the MAP of two groups after treatment.There were no significant differences in the incidence of air leak between the CMV group and the HFOV group(24.2％ vs.16.7％).The mortality rate of CMV group and HFOV group was respectively 45.5 ％ and 33.3 ％,and there was no statistically significant difference.Conclusion HFOV was effective in oxygenation and seems to be safe for pediatric patients with measles complicated with severe pneumonia and the ARDS.Also it didn't influence the occurrence of complications.It has no adverse influence on hemodynamic parameters.Early intervention of HFOV is safe and effective for the children with measles complicated with severe pneumonia and ARDS.