高频振荡通气成功救治腺病毒感染致小儿严重急性呼吸窘迫综合征合并气漏一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

郭予雄 , 王雪莲 , 孙跃玉 , 钟敏泉 , 林晓源 ,  何少茹 , 昌艳军

广东省人民医院广东省医学科学院儿科重症监护室(广东广州 510080);

Corresponding author：

何少茹, Email: hsr1605@163.com

Keywords：

急性呼吸窘迫综合征; 高频振荡通气; 气胸; 气漏; 腺病毒; 儿童

DOI：

10.7507/1671-6205.2015020

Video：

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目的探讨高频振荡通气(HFOV)在小儿重度急性呼吸窘迫综合征(ARDS)合并气漏中的应用价值及安全性。方法结合1例腺病毒感染致重度ARDS合并大量气胸患儿的临床资料及国内外相关文献, 评价早期HFOV在儿童重度ARDS综合治疗中的价值。结果患儿机械通气前动脉血PaO₂/FiO₂为41 mm Hg, 氧合指数(OI)为35, 动脉血PaCO₂为72 mm Hg, SaO₂为10%。放置胸腔引流管, 约2 h换用HFOV, 在咪达唑仑、芬太尼基础上加用维库溴铵以保证人机的协调性。患儿气漏逐渐稳定吸收, PaO₂/FiO₂逐日升高, OI逐日下降, PaCO₂维持在50~60 mm Hg。开始运用HFOV时患儿心率增快, 血压进行性下降, 经生理盐水、白蛋白扩容以及去甲肾上腺素、多巴胺升压后稳定。共使用HFOV治疗7 d, 常规频率机械通气2 d, 住院10 d后转出儿科重症监护室, 一共住院3周, 痊愈出院。结论早期应用HFOV对改善大量气漏的重度ARDS患儿的通气和氧合有益, 但HFOV对血流动力学有影响。

Citation： 郭予雄, 王雪莲, 孙跃玉, 钟敏泉, 林晓源, 何少茹, 昌艳军. 高频振荡通气成功救治腺病毒感染致小儿严重急性呼吸窘迫综合征合并气漏一例. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(1): 84-87. doi: 10.7507/1671-6205.2015020 Copy

1.	喻文亮, 钱素云, 陶建平, 主编.小儿机械通气.上海:上海科学技术出版社, 2012.
2.	Clark RH.High frequency ventilation.J Pediatr, 1994, 124:661-670.
3.	Lunkenheimer PP, Rafflenbeul W, Keller H, et al.Application of transtracheal pressure oscillations as modification of "diffusing respiration".Br J Anaesth, 1972, 44:627.
4.	喻文亮.急性呼吸窘迫综合征与机械通气策略.中国实用儿科杂志, 2010, 25:97-101.
5.	邓妮, 王鹏张, 婷夏高, 等.高频振荡通气在成人急性呼吸窘迫综合征的应用.中国呼吸与危重监护杂志, 2013, 12:100-104.
6.	Marchak RH, Thompson WK, Duffy P, et al.Treatment of RDS by high frequency oscillatory ventilation:a preliminary report.J Pediatr, 1981, 99:287-292.
7.	Gupta P, Green JW, Tang X, et al.Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.JAMA Pediatr, 2014, 168:243-249.
8.	Arnold JH.High-frequency ventilation in the pediatric intensive care unit.Pediatr Crit Care Med, 2000, 1:93-99.
9.	Faqih NA, Qabba'h SH, Rihani RS, et al.The use of high frequency oscillatory ventilation in a pediatric oncology intensive care unit.Pediatr Blood Cancer, 2012, 58:384-389.
10.	Babbitt CJ, Cooper MC, Nussbaum E, et al.High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure:disease-specific morbidity survival analysis.Lung, 2012, 190:685-690.
11.	Moniz M, Silvestre C, Nunes P, et al.High-frequency oscillatory ventilation in children:a 10-year experience. J Pediatr (Rio J), 2013, 89:48-55.
12.	Martinón Torres F, Rodríguez Núñez A, Jaimovich DG, et al.High-frequency oscillatory ventilation in pediatric patients.Protocol and preliminary results.An Esp Pediatr, 2000, 53:305-313.
13.	Clark RH, Gerstmann DR, Null DM Jr, et al.Prospective randomized comparison of high frequency oscillatory ventilation and conventional ventilation in respiratory distress syndrome.Pediatrics, 1992, 89:5-12.
14.	Pinzon AD, Rocha TS, Ricachinevsky C, et al.High-frequency oscillatory ventilation in children with acute respiratory distress syndrome:experience of a pediatric intensive care unit.Rev Assoc Med Bras, 2013, 59:368-374.
15.	Rowan CM, Cristea O, Greathouse ST, et al.Preemptive use of high-frequency oscillatory ventilation in pediatric burn patients.J Burn Care Res, 2013, 34, 237-242.
16.	Fedora M, Klimovic M, Seda M, et al.Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome.Bratisl Lek Listy, 2000, 101:8-13.
17.	Wang CC, Wu WL, Wu ET, et al.High frequency oscillatory ventilation in children:experience of a medical center in Taiwan.J Formos Med Assoc, 2008, 107:311-315.
18.	Ben Jaballah N, Khaldi A, Mnif K, et al.High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.Pediatr Crit Care Med, 2006, 7:362-367.
19.	Yildizdas D, Yapicioglu H, Bayram I, et al.High-frequency oscillatory ventilation for acute respiratory distress syndrome.Indian J Pediatr, 2009, 76:921-927.
20.	Luyt CÉ, Combes A, Trouillet JL, et al.Virus-induced acute respiratory distress syndrome:epidemiology, management and outcome.Presse Med, 2011, 40:e561-e568.
21.	Goh AY, Chan PW, Roziah M.Surfactant replacement therapy in RSV-induced acute respiratory distress syndrome (ARDS).Singapore Med J, 1999, 40:113-116.
22.	Piastra M, Onesimo R, De Luca D, et al.Measles-induced respiratory distress, air-leak and ARDS.Eur J Clin Microbiol Infect Dis, 2010, 29:181-185.
23.	Bhanthumkosol D.Fatal adenovirus infections in infants probably infected with HIV.J Med Assoc Thai, 1998, 81, 214-222.
24.	Choi J, Kim YS, Kim MS, et al.Acute respiratory distress syndrome by cytomegalovirus infection in an immunocompetent infant.Pediatr Pulmonol, 2008, 43:824-827.
25.	Rankin N, Day AC, Crone PD.Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation.Case report.J Trauma, 1994, 36:428-429.
26.	Dodds CP, Hillman KM.Management of massive air leak with asynchronous independant lung ventilation.Intensive Care Med, 1982, 8:287-290.
27.	Reiche-Fischel O, Helfrick JF.Intraoperative life-threatening emphysema associated with endotracheal intubation and air insufation devices:report of two cases.J Oral Maxillofac Surg, 1995, 53:1103-1107.
28.	Shen HN, Lu FL, Wu HD, et al.Management of tension pneumatocele with high-frequency oscillatory ventilation.Chest, 2002, 121:284-286.
29.	Markus-Rodden MM, Bojko T, Hauck LC.Traumatic tracheal laceration in a pediatric patient medically managed with high-frequency oscillatory ventilation.Pediatr Emerg Care, 2008, 24:236-237.
30.	陈丹, 黄西林, 李小萍.高频振荡通气在新生儿气胸治疗中的临床观察.中国当代儿科杂志, 2012, 12:499-501.
31.	Hraiech S, Forel JM, Papazian L.The role of neuromuscular blockers in ARDS:benefits and risks.Curr Opin Crit Care, 2012, 18:495-502.

1. 喻文亮, 钱素云, 陶建平, 主编.小儿机械通气.上海:上海科学技术出版社, 2012.
2. Clark RH.High frequency ventilation.J Pediatr, 1994, 124:661-670.
3. Lunkenheimer PP, Rafflenbeul W, Keller H, et al.Application of transtracheal pressure oscillations as modification of "diffusing respiration".Br J Anaesth, 1972, 44:627.
4. 喻文亮.急性呼吸窘迫综合征与机械通气策略.中国实用儿科杂志, 2010, 25:97-101.
5. 邓妮, 王鹏张, 婷夏高, 等.高频振荡通气在成人急性呼吸窘迫综合征的应用.中国呼吸与危重监护杂志, 2013, 12:100-104.
6. Marchak RH, Thompson WK, Duffy P, et al.Treatment of RDS by high frequency oscillatory ventilation:a preliminary report.J Pediatr, 1981, 99:287-292.
7. Gupta P, Green JW, Tang X, et al.Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.JAMA Pediatr, 2014, 168:243-249.
8. Arnold JH.High-frequency ventilation in the pediatric intensive care unit.Pediatr Crit Care Med, 2000, 1:93-99.
9. Faqih NA, Qabba'h SH, Rihani RS, et al.The use of high frequency oscillatory ventilation in a pediatric oncology intensive care unit.Pediatr Blood Cancer, 2012, 58:384-389.
10. Babbitt CJ, Cooper MC, Nussbaum E, et al.High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure:disease-specific morbidity survival analysis.Lung, 2012, 190:685-690.
11. Moniz M, Silvestre C, Nunes P, et al.High-frequency oscillatory ventilation in children:a 10-year experience. J Pediatr (Rio J), 2013, 89:48-55.
12. Martinón Torres F, Rodríguez Núñez A, Jaimovich DG, et al.High-frequency oscillatory ventilation in pediatric patients.Protocol and preliminary results.An Esp Pediatr, 2000, 53:305-313.
13. Clark RH, Gerstmann DR, Null DM Jr, et al.Prospective randomized comparison of high frequency oscillatory ventilation and conventional ventilation in respiratory distress syndrome.Pediatrics, 1992, 89:5-12.
14. Pinzon AD, Rocha TS, Ricachinevsky C, et al.High-frequency oscillatory ventilation in children with acute respiratory distress syndrome:experience of a pediatric intensive care unit.Rev Assoc Med Bras, 2013, 59:368-374.
15. Rowan CM, Cristea O, Greathouse ST, et al.Preemptive use of high-frequency oscillatory ventilation in pediatric burn patients.J Burn Care Res, 2013, 34, 237-242.
16. Fedora M, Klimovic M, Seda M, et al.Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome.Bratisl Lek Listy, 2000, 101:8-13.
17. Wang CC, Wu WL, Wu ET, et al.High frequency oscillatory ventilation in children:experience of a medical center in Taiwan.J Formos Med Assoc, 2008, 107:311-315.
18. Ben Jaballah N, Khaldi A, Mnif K, et al.High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.Pediatr Crit Care Med, 2006, 7:362-367.
19. Yildizdas D, Yapicioglu H, Bayram I, et al.High-frequency oscillatory ventilation for acute respiratory distress syndrome.Indian J Pediatr, 2009, 76:921-927.
20. Luyt CÉ, Combes A, Trouillet JL, et al.Virus-induced acute respiratory distress syndrome:epidemiology, management and outcome.Presse Med, 2011, 40:e561-e568.
21. Goh AY, Chan PW, Roziah M.Surfactant replacement therapy in RSV-induced acute respiratory distress syndrome (ARDS).Singapore Med J, 1999, 40:113-116.
22. Piastra M, Onesimo R, De Luca D, et al.Measles-induced respiratory distress, air-leak and ARDS.Eur J Clin Microbiol Infect Dis, 2010, 29:181-185.
23. Bhanthumkosol D.Fatal adenovirus infections in infants probably infected with HIV.J Med Assoc Thai, 1998, 81, 214-222.
24. Choi J, Kim YS, Kim MS, et al.Acute respiratory distress syndrome by cytomegalovirus infection in an immunocompetent infant.Pediatr Pulmonol, 2008, 43:824-827.
25. Rankin N, Day AC, Crone PD.Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation.Case report.J Trauma, 1994, 36:428-429.
26. Dodds CP, Hillman KM.Management of massive air leak with asynchronous independant lung ventilation.Intensive Care Med, 1982, 8:287-290.
27. Reiche-Fischel O, Helfrick JF.Intraoperative life-threatening emphysema associated with endotracheal intubation and air insufation devices:report of two cases.J Oral Maxillofac Surg, 1995, 53:1103-1107.
28. Shen HN, Lu FL, Wu HD, et al.Management of tension pneumatocele with high-frequency oscillatory ventilation.Chest, 2002, 121:284-286.
29. Markus-Rodden MM, Bojko T, Hauck LC.Traumatic tracheal laceration in a pediatric patient medically managed with high-frequency oscillatory ventilation.Pediatr Emerg Care, 2008, 24:236-237.
30. 陈丹, 黄西林, 李小萍.高频振荡通气在新生儿气胸治疗中的临床观察.中国当代儿科杂志, 2012, 12:499-501.
31. Hraiech S, Forel JM, Papazian L.The role of neuromuscular blockers in ARDS:benefits and risks.Curr Opin Crit Care, 2012, 18:495-502.

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高频振荡通气成功救治腺病毒感染致小儿严重急性呼吸窘迫综合征合并气漏一例

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