高频振荡机械通气治疗5例甲型H1N1流感患者呼吸衰竭的临床体会

目的探讨高频振荡通气（HFOV）在甲型H1N1流感患者呼吸衰竭治疗中的应用价值及安全性。方法采用自身对照研究,5例呼吸衰竭甲型H1N1流感患者经常规机械通气（CMV）治疗无效后改用HFOV治疗,观察治疗前后血气[氧分压（PaO2）、二氧化碳分压（PCO2）、pH]、呼吸力学指标[氧浓度（FiO2）、平均气道压（Paw）、静态顺应（Cst）、氧合指数（PaO2/FiO2）]的变化,分析肺活检病理资料及临床治疗效果。结果经HFOV治疗后6~8h,3例患者氧合较前改善,24~48h后明显改善,48~72h后改为CMV,144h后成功脱机;2例患者经HFOV治疗,8h内病情恶化改用CMV治疗,1例75...

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Published in解放军医学杂志 Vol. 36; no. 8; pp. 800 - 803
Main Author 张志刚 石斌 李斌 刘丽平 郭鸿 尹超 侯启亮
Format Journal Article
LanguageChinese
Published 2011
Subjects
呼吸功能不全
流感病毒A型,H1N1亚型
高频通气
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ISSN0577-7402

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Summary:目的探讨高频振荡通气（HFOV）在甲型H1N1流感患者呼吸衰竭治疗中的应用价值及安全性。方法采用自身对照研究,5例呼吸衰竭甲型H1N1流感患者经常规机械通气（CMV）治疗无效后改用HFOV治疗,观察治疗前后血气[氧分压（PaO2）、二氧化碳分压（PCO2）、pH]、呼吸力学指标[氧浓度（FiO2）、平均气道压（Paw）、静态顺应（Cst）、氧合指数（PaO2/FiO2）]的变化,分析肺活检病理资料及临床治疗效果。结果经HFOV治疗后6~8h,3例患者氧合较前改善,24~48h后明显改善,48~72h后改为CMV,144h后成功脱机;2例患者经HFOV治疗,8h内病情恶化改用CMV治疗,1例75h后死亡,1例经体外膜氧合（ECMO）治疗145h后死亡。结论 HFOV可明显改善甲型H1N1流感呼吸衰竭患者的预后,与CMV序贯治疗可以降低并发症发生率病死率。
Bibliography:Objective To investigate the application and safety of high-frequency oscillation ventilation（HFOV） in the treatment of patients suffering from H1N1 influenza with respiratory failure.Methods Self-control study was conducted.The treatment of five H1N1 influenza patients with respiratory failure was switched to HFOV after failure of conventional mechanical ventilation（CMV）.Blood gas [partial pressure of oxygen（PaO2）,partial pressure of carbon dioxide（PCO2）,pH],respiratory mechanics indices [oxygen concentration（FiO2）,mean airway pressure（Paw）,static response（Cst）,oxygenation index（PaO2/FiO2）] before and after treatment were observed.Lung biopsy and clinical treatment data were also analyzed.Results Oxygenation was improved in 3 patients 6 to 8 hours after HFOV treatment,and marked improvement was observed after 24-48h.48-72h later,HFOV was replaced by CMV,and the patients weaned from mechanical ventilation successfully at 144h.In two patients symptoms were exacerbated after HFOV for 8 hours and the treatment w
ISSN:0577-7402