Herterich R, Fackeldey E, Hofweber K, Steck W, Neumaier F, Arends H
Kinderklinik St. Marien Landshut.
Klin Padiatr. 1994 Mar-Apr;206(2):80-5. doi: 10.1055/s-2008-1046587.
Within one year 3 newborns with meconium-aspiration and 4 infants with bronchopulmonary dysplasia (BPD) were treated with HFP, synchronous with conventional ventilation (CMV). The entrance criteria were insufficient oxygenation (PO2/FiO2 < 50 mmHg) and/or CO2-elimination (> 60 mmHg), respectively peak inspiratory pressure Pi > 40 mmHg and mean airway pressure MAP > 20 mbar during CMV. All three cases of meconium-aspiration have shown a striking improvement in oxygenation and ventilation, in one case starting from a disastrous situation with PCO2 > 90 mmHg, PO2 30 mmHg (FiO2 100%). After a HFO period of 9 to 10 hours Pi, MAP and CMV-frequency could be reduced. The patients could be extubated after 1-2 weeks. In severe BPD only in one case continuous improvement and extubation in the 4. week of life were possible. Here the pulmonary artery pressure in doppler-echocardiography slightly was elevated (30-35 mmHg). In a further case extubation was possible after several trials with HFO. Indeed chronic respiratory insufficiency, progredient pulmonary emphysema on x-ray and clearly elevated pulmonary artery pressure (> 40 mmHg) persisted. In 2 further cases there was no longstanding improvement of ventilation. One child died after 8 months, one after 6 months. In both cases there was a right-to-left shunt over foramen ovale and pulmonary artery pressures at systemic level. HFO led to an improvement in oxygenation and ventilation in all three cases of meconium-aspiration and probably prevented a fatal outcome in one case. The effect seems to depend on improved secretolysis and gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS)
在一年内，3例胎粪吸入新生儿和4例支气管肺发育不良（BPD）婴儿接受了高频振荡通气（HFP）治疗，并与传统通气（CMV）同步进行。入选标准分别为氧合不足（PO2/FiO2 < 50 mmHg）和/或二氧化碳清除障碍（> 60 mmHg），在CMV期间吸气峰压Pi > 40 mmHg且平均气道压MAP > 20 mbar。所有3例胎粪吸入病例的氧合和通气均有显著改善，其中1例初始情况极为糟糕，PCO2 > 90 mmHg，PO2 30 mmHg（FiO2 100%）。经过9至10小时的高频振荡通气期后，Pi、MAP和CMV频率得以降低。患者在1 - 2周后可拔除气管插管。在重度BPD中，仅1例在出生后第4周持续改善并成功拔管。在此病例中，多普勒超声心动图显示肺动脉压略有升高（30 - 35 mmHg）。在另一例中，经过多次高频振荡通气试验后成功拔管。然而，慢性呼吸功能不全、X线显示进行性肺气肿以及明显升高的肺动脉压（> 40 mmHg）依然存在。另外2例通气情况未得到长期改善。1例患儿在8个月后死亡，另1例在6个月后死亡。这两例均存在卵圆孔右向左分流且肺动脉压达体循环水平。高频振荡通气使所有3例胎粪吸入病例的氧合和通气得到改善，可能还在1例中避免了致命结局。其效果似乎取决于分泌物溶解和气体交换的改善。（摘要截选至250字）
