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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。
We performed 32 HFV episodes in 25 critically ill children in the PICU (18.6% of patients with mechanical ventilation during the same period). There were 6 cases of mixed high-frequency ventilation (CHFV), 10 cases of high-frequency jet ventilation (HFJV) and 2 cases of high-frequency positive pressure ventilation (HFPPV). Age range: 1 day to 10 years old, the main primary disease: severe pneumonia with respiratory failure, heart failure, cardiopulmonary resuscitation, severe bronchial asthma, respiratory distress syndrome. Nasal endotracheal intubation is the main route of high-frequency ventilation. The results showed that PaO_2 and PaO_2 / Fio 2 increased significantly (P <0.01), PaCO_2 and PH had no significant change (P> 0.05) There was no CO_2 retention in the HF group, suggesting that the mean Paw and PIP values were lower than those of the normal HF alone. This article on the indications for high-frequency ventilation, high-frequency respirator parameters slightly discussed. And pointed out: CO_2 retention and inadequate airway humidification is still the main problems in the application of high frequency jet ventilation, this can be taken alternately with the frequent use of ventilation, attention to adjust the driving force and frequency parameters and to strengthen airway management and other methods to be solve.