Wiswell T E, Clark R H, Null D M, Kuehl T J, deLemos R A, Coalson J J
Neonatology Services, Brooke Army Medical Center, San Antonio, Texas.
J Pediatr. 1988 Feb;112(2):249-56. doi: 10.1016/s0022-3476(88)80065-9.
We compared the histopathologic changes in the airways of premature baboons treated with conventional positive-pressure ventilation (PPV) with those seen after high-frequency oscillatory ventilation (HFOV) and high-frequency flow interruption (HFFI). Twenty-six animals were treated with ventilation for 24 hours (five PPV, 10 HFOV, 11 HFFI), and 18 were treated with ventilation for 96 hours (six PPV, six HFOV, six HFFI). A semiquantitative scoring system was used to grade tissue changes in the trachea, carina, and both main-stem bronchi. Alterations were produced by all forms of mechanical ventilation. The degree of injury was similar and relatively mild for the PPV- and HFOV-treated animals at both 24 and 96 hours. Eleven of 17 baboons treated with HFFI ventilation (8/11 at 24 hours; 3/6 at 96 hours) had severe airway damage characterized by diffuse submucosal necrosis, extensive hemorrhage, dense polymorphonuclear leukocyte infiltration, sloughed epithelium, focal basophilia, and intraluminal debris. HFOV resulted in no greater degree of airway damage than did PPV. The use of HFFI, with the particular strategy we employed, resulted in a far greater degree of damage than either PPV (P less than 0.01) or HFOV.
我们比较了接受传统正压通气（PPV）治疗的早产狒狒气道的组织病理学变化与高频振荡通气（HFOV）和高频气流阻断（HFFI）后所见的变化。26只动物接受了24小时的通气治疗（5只接受PPV，10只接受HFOV，11只接受HFFI），18只接受了96小时的通气治疗（6只接受PPV，6只接受HFOV，6只接受HFFI）。使用半定量评分系统对气管、隆突和双侧主支气管的组织变化进行分级。所有形式的机械通气均会产生改变。在24小时和96小时时，接受PPV和HFOV治疗的动物的损伤程度相似且相对较轻。接受HFFI通气治疗的17只狒狒中有11只（24小时时8/11；96小时时3/6）出现严重气道损伤，其特征为弥漫性黏膜下坏死、广泛出血、密集的多形核白细胞浸润、上皮脱落、局灶性嗜碱性变和管腔内碎屑。HFOV导致的气道损伤程度并不比PPV更大。采用我们所采用的特定策略，HFFI造成的损伤程度比PPV（P<0.01）或HFOV都要大得多。
