Keszler M, Donn S M, Bucciarelli R L, Alverson D C, Hart M, Lunyong V, Modanlou H D, Noguchi A, Pearlman S A, Puri A
Department of Pediatrics, Georgetown University, Washington, D.C.
J Pediatr. 1991 Jul;119(1 Pt 1):85-93. doi: 10.1016/s0022-3476(05)81046-7.
One hundred forty-four newborn infants with pulmonary interstitial emphysema were stratified by weight and severity of illness, and randomly assigned to receive treatment with high-frequency jet ventilation (HFJV) or rapid-rate conventional mechanical ventilation (CV) with short inspiratory time. If criteria for treatment failure were met, crossover to the alternate ventilatory mode was permitted. Overall, 45 (61%) of 74 infants met treatment success criteria with HFJV compared with 26 (37%) of 70 treated with CV (p less than 0.01). Eighty-four percent of patients who crossed over from CV to HFJV initially responded to the new treatment, and 45% ultimately met success criteria on HFJV. In contrast, only 9% of those who crossed over from HFJV to CV responded well to CV (p less than 0.01), and the same 9% ultimately met success criteria (p less than 0.05). Therapy with HFJV resulted in improved ventilation at lower peak and mean airway pressures, as well as more rapid radiographic improvement of pulmonary interstitial emphysema, in comparison with rapid-rate CV. Survival by original assignment was identical. When survival resulting from rescue by the alternate therapy in crossover patients was excluded, the survival rate was 64.9% for HFJV, compared with 47.1% for CV (p less than 0.05). The incidence of chronic lung disease, intraventricular hemorrhage, patent ductus arteriosus, airway obstruction, and new air leak was similar in both groups. We conclude that HFJV, as used in this study, is safe and is more effective than rapid-rate CV in the treatment of newborn infants with pulmonary interstitial emphysema.
144例患有肺间质气肿的新生儿按体重和疾病严重程度分层，然后随机分配接受高频喷射通气（HFJV）治疗或短吸气时间的快速常规机械通气（CV）治疗。如果符合治疗失败标准，则允许交叉使用另一种通气模式。总体而言，74例接受HFJV治疗的婴儿中有45例（61%）达到治疗成功标准，而70例接受CV治疗的婴儿中有26例（37%）达到该标准（p<0.01）。从CV交叉至HFJV的患者中，84%最初对新治疗有反应，45%最终在HFJV治疗下达到成功标准。相比之下，从HFJV交叉至CV的患者中只有9%对CV反应良好（p<0.01），同样9%最终达到成功标准（p<0.05）。与快速CV相比，HFJV治疗可在较低的峰值和平均气道压力下改善通气，并且肺间质气肿的影像学改善更快。按最初分配的生存率相同。排除交叉患者中通过替代疗法挽救后的生存情况，HFJV的生存率为64.9%，而CV为47.1%（p<0.05）。两组慢性肺病、脑室内出血、动脉导管未闭、气道梗阻和新的气漏发生率相似。我们得出结论，本研究中使用的HFJV在治疗患有肺间质气肿的新生儿方面是安全的，且比快速CV更有效。
