Spitzer A R, Butler S, Fox W W
Division of Neonatology, Children's Hospital of Philadelphia, PA.
Pediatr Pulmonol. 1989;7(4):244-50. doi: 10.1002/ppul.1950070410.
High frequency jet ventilation (HFJV) was used to treat 176 infants who were either failing to respond to conventional mechanical ventilation (CMV) or demonstrating pulmonary air leak. The median birthweight for infants treated with HFJV was 1530 g, median gestational age was 31 weeks. Median duration of therapy with HFJV was 3.0, with a range of 0.1 to 27 days. During the first 24 hours of treatment, mean airway pressure decreased from 16.2 +/- 0.3 (Mean +/- SEM) cmH2O to 12.2 +/- 0.3 cmH2O, while mean PaO2 increased from 65.3 +/- 3.0 torr to 93.3 +/- 3.0 torr during the same time period. Simultaneously, mean PaCO2 decreased from 46.4 +/- 1.5 torr to 36.6 +/- 1.0 torr, although peak inflating pressure decreased from 34.3 +/- 0.7 cmH2O to 30.1 +/- 0.8 cmH2O. Ninety-five (54%) infants treated with HFJV survived. Of 123 infants with RDS 75 (61%) survived. The rate of complications for HFJV patients was similar to that seen with CMV in our nursery. This study suggests that HFJV provides improved oxygenation and ventilation of infants at lower mean and peak pressures compared to conventional mechanical ventilation. HFJV combined with CMV may be a valuable adjunct to therapy in infants with severe lung disease.
高频喷射通气（HFJV）用于治疗176例对传统机械通气（CMV）无反应或出现肺漏气的婴儿。接受HFJV治疗的婴儿中位出生体重为1530克，中位胎龄为31周。HFJV治疗的中位持续时间为3.0天，范围为0.1至27天。在治疗的前24小时内，平均气道压力从16.2±0.3（均值±标准误）厘米水柱降至12.2±0.3厘米水柱，而同期平均动脉血氧分压（PaO2）从65.3±3.0托升至93.3±3.0托。同时，平均动脉血二氧化碳分压（PaCO2）从46.4±1.5托降至36.6±1.0托，尽管峰值充气压力从34.3±0.7厘米水柱降至30.1±0.8厘米水柱。接受HFJV治疗的95例（54%）婴儿存活。123例呼吸窘迫综合征（RDS）婴儿中有75例（61%）存活。HFJV患者的并发症发生率与我们新生儿重症监护室中CMV治疗患者的并发症发生率相似。本研究表明，与传统机械通气相比，HFJV在较低的平均和峰值压力下能改善婴儿的氧合和通气。HFJV联合CMV可能是重症肺病婴儿治疗中有价值的辅助治疗方法。
