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題 名 | High-Frequency Oscillatory Ventilation for Infants and Children with Adult Respiratory Distress Syndrome=振動式高頻呼吸器使用於罹患成人型呼吸窘迫症候群之嬰兒及兒童 |
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作 者 | 唐禎瑞; 鄒國英; 施相宏; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷 期 | 38:2 民86.03-04 |
頁 次 | 頁137-144+171 |
分類號 | 417.5311 |
關鍵詞 | 成人型呼吸窘迫症候群; 振動式高頻呼吸器; 傳統呼吸器; Adult respiratory distress syndrome; Conventional mechanical ventilation; High-frequency oscillatory ventilation; |
語 文 | 英文(English) |
中文摘要 | 在一年的研究期間,經診斷為成人型呼吸窘迫症候群(adult respiratory distress syndrome )的病人中,有四個病人(包括兩個新生兒及兩個兒童)在使用傳統呼 吸器( conventional ventilator )治療下, 仍有血氧嚴重偏低、動脈氧分壓對肺泡氧分 壓的比值( a/APO �� ratio )小於 0.1 持續達三小時以上, 因而改用振動式高頻呼吸器 ( high-frequency oscillatory ventilator )配合 " 高肺容積 " 策略( high-lung-volume strategy )來治療。治療開始後六小時內,有三個病人之血氣隨即明顯 改善:動脈氧分壓對肺泡氧分壓的比值顯著上升, 氧化指數( oxygenation index )顯著 下降。經振動式高頻呼吸器治療平均達九十六小時後,有三個病人成功轉回傳統呼吸器,最 後成功移除呼吸器並順利出院。另一名病人雖在使用振動式高頻呼吸器後最初二十小時肉, 血氧有明顯而穩定的上升,但最後仍死於巨細胞病毒肺炎合併大量肺出血。有兩位病人於振 動式高頻呼吸器使用下發生氣胸,經調降振幅及平均氣道壓力後,氣胸消失。根據此研究結 果,對患有成人型呼吸窘迫症候群的嬰兒及兒童,在傳統呼吸治療下無改善跡象時,振動式 高頻呼吸器合併 " 高肺容積 " 策略可作為一有效的挽救治療法。 |
英文摘要 | Two infants and two children suffered from severe hypoxemia, presenting as a ratio of arterial to alveolar PaO �� <0.1, persisting for more than 3 hours in spite of high settings on conventional mechanical ventilator. Adult respiratory distress syndrome was diagnosed with the support of bilateral diffuse haziness on chest radiographs. High-frequency oscillatory ventilation with high-lung-volume strategy resulted in prompt decrease in oxygenation index and increase in ratio of arterial to alveolar P O �� in three (75%) of the 4 patients within 6 hours. After a mean duration of 96 hours, high-frequency oscillatory ventilation could be weaned off and conventional ventilation could be resumed at lower mean airway pressure in 3 patients. They continued to improve and finally recovered. The other one showed initially steady improvement on high-frequency oscillatory ventilation for 20 hours, but ultimately died of unresolved cytomegalovirus pneumonitis and intractable pulmonary hemorrhage. There were 2 episodes of pneumothorax developing during high-frequency oscillatory hemorrhage. There were 2 episodes of pneumothorax developing during high-frequency oscillatory ventilation. After decreasing mean airway pressure and amplitude, the airleak resolved with chest tube insertion. We conclude that high-frequency oscillatory ventilation with high-lung -volume strategy may be an effective rescue therapy to relieve profound hypoxemia in infants and children with adult respiratory distress syndrome. |
本系統中英文摘要資訊取自各篇刊載內容。