Schwendeman C A, Clark R H, Yoder B A, Null D M, Gerstmann D R, Delemos R A
Wilford Hall USAF Medical Center, Lackland Air Force Base, TX.
Crit Care Med. 1992 Mar;20(3):372-7. doi: 10.1097/00003246-199203000-00014.
To assess the frequency of chronic lung disease and factors associated with its development in term infants with severe respiratory failure who receive high-frequency oscillatory ventilation, or high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation (ECMO).
Retrospective review of pulmonary outcome of all ECMO candidates admitted to Wilford Hall USAF Medical Center between July 1985 and September 1989.
A tertiary, level III, neonatal ICU accepting regional referrals for high-frequency ventilation and ECMO.
Ninety-four patients who were candidates for ECMO were studied. High-frequency oscillatory ventilation alone was used in 48 infants. Forty-six infants were treated with high-frequency oscillatory ventilation and ECMO.
Twenty (24%) of 84 survivors developed chronic lung disease. There were no differences in gestational age, birth weight, or gender between those infants who developed chronic lung disease and those infants who did not. Arterial blood gas and ventilatory settings at initiation of high-frequency oscillatory ventilation were similar between those infants who did and those who did not develop chronic disease. Patients who developed chronic lung disease more often had lung hypoplasia (40% vs. 5%) and more often required ECMO (75% vs. 39%) than those patients who did not. In patients without lung hypoplasia, those patients who developed chronic lung disease were older at initiation of high-frequency oscillatory ventilation rescue than those patients who did not develop chronic lung disease (median 91 vs. 46 hrs).
The frequency of chronic lung disease in ECMO candidates is clinically important. Factors associated with chronic lung disease in ECMO candidates are: the presence of lung hypoplasia, delayed referral, and the need for ECMO to support gas exchange.
评估接受高频振荡通气或高频振荡通气联合体外膜肺氧合（ECMO）治疗的重症呼吸衰竭足月儿慢性肺病的发生率及其相关因素。
对1985年7月至1989年9月间入住美国空军威尔福德·霍尔医疗中心的所有ECMO候选患儿的肺部转归进行回顾性研究。
一家接受高频通气和ECMO区域转诊的三级、Ⅲ级新生儿重症监护病房。
对94例ECMO候选患儿进行研究。48例婴儿仅接受高频振荡通气治疗。46例婴儿接受高频振荡通气联合ECMO治疗。
84例存活患儿中有20例（24%）发生慢性肺病。发生慢性肺病的患儿与未发生慢性肺病的患儿在胎龄、出生体重或性别方面无差异。发生慢性肺病和未发生慢性肺病的患儿在开始高频振荡通气时的动脉血气和通气参数相似。发生慢性肺病的患儿比未发生慢性肺病的患儿更常出现肺发育不全（40%对5%），且更常需要ECMO（75%对39%）。在无肺发育不全的患儿中，发生慢性肺病的患儿开始高频振荡通气抢救时的年龄比未发生慢性肺病的患儿大（中位数91小时对46小时）。
ECMO候选患儿中慢性肺病的发生率具有临床重要性。与ECMO候选患儿慢性肺病相关的因素包括：肺发育不全、转诊延迟以及需要ECMO支持气体交换。
