Sakai T, Aiba S, Takahashi R, Yoshioka T, Iinuma K
Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
Tohoku J Exp Med. 1996 Dec;180(4):327-35. doi: 10.1620/tjem.180.327.
We retrospectively reviewed data on high frequency oscillatory ventilation (HFOV) settings and pulmonary function in 14 extremely low birth weight infants who were treated with piston-type HFOV immediately after birth for severe respiratory distress to investigate the cause of pulmonary interstitial emphysema (PIE) associated with HFOV. PIE developed a mean of 23 hr after the initiation of HFOV in 6 infants. Eight infants did not develop PIE and served as the control group. The lowest mean airway pressure (MAP) in the PIE group, which occurred immediately before disease onset was 5.2 cm H2O. The lowest MAP in the control group was 7.5 cm H2O (p < 0.01), which occurred immediately before the ventilatory mode was changed from HFOV to conventional mechanical ventilation for weaning from mechanical ventilation. Respiratory system compliance (Crs) 12 hr after birth was below normal in both groups and there was no significant difference between groups. These results suggest that an unusually low MAP may contribute to PIE during piston-type HFOV in the presence of low Crs. It is therefore important to maintain a high MAP during HFOV until pulmonary compliance becomes normal.
我们回顾性分析了14例极低出生体重儿的高频振荡通气（HFOV）设置和肺功能数据，这些患儿出生后立即接受活塞式HFOV治疗以缓解严重呼吸窘迫，旨在探究与HFOV相关的肺间质气肿（PIE）的病因。6例患儿在开始HFOV后平均23小时出现PIE。8例未发生PIE的患儿作为对照组。PIE组在疾病发作前即刻出现的最低平均气道压（MAP）为5.2 cmH₂O。对照组最低MAP为7.5 cmH₂O（p<0.01），出现在从HFOV转换为传统机械通气以撤机前即刻。两组出生后12小时的呼吸系统顺应性（Crs）均低于正常，且组间无显著差异。这些结果表明，在Crs较低的情况下，异常低的MAP可能导致活塞式HFOV期间发生PIE。因此，在HFOV期间维持较高的MAP直至肺顺应性恢复正常很重要。
