Factors Associated with High-frequency Oscillatory Ventilation Response in Infants with Respiratory Failure

呼吸衰竭嬰兒以高頻振頻幅呼吸療法治療療效因素之探討

鄒國英(Kuo-Inn Tsou Yau) ； 唐禎瑞(Jen-Ruey Tang)

《Acta Paediatrica Sinica》 39卷3期 (1998/06) Pp. 166-172

https://doi.org/10.7097/APS.199806.0166

摘要

為了解罹患呼吸衰竭，且使用傳統呼吸器及藥物治療均無效之嬰兒，使用高頻振幅呼吸治療時，與其治療效果及預後相關之因素，我們進行了一前瞻性之臨床研究。共有24病人（包括14位早產兒）在1至127天大時接受30次的高頻振幅呼吸治療。在治療後6至8小時，57%之反應良好，20%沒有改善，另有23%在治療後10至24小時才有進步；35%反應良好的病人之後呼吸狀況變壞。17次的治療（57%，10次層療效良好者，2次層療效不好者，5次屬療效延遲者）在使用高頻振幅呼吸器4.6±2.5天後，可逐漸停止高頻幅呼吸器之使用。
對高頻振幅呼吸療法反應不好或無法順利中止高頻呼吸治療的病人多為肺部疾病較嚴重（oxygenation index或mean airway pressure較高）或是需要其他輔助性治療的病人。早產兒和罹患新生兒持續性肺高壓症病之治療效果不錯。在使用新療法6至8小時後之反應無法預測病人之存活或是否能順利中止高頻呼吸治療。
由此研究之結果，我們得知罹患呼吸衰竭病人在傳統治療無效時，採用高頻振幅呼吸治療是有效的。肺部疾病很嚴重者或是需要其它輔助性治療的病人，單獨使用高頻振幅呼吸器治療後，呼吸狀態雖然沒有很明顯的進步，但也沒變壞時，應繼續使用高頻振幅呼吸器至24小時，有些病人稍晚仍會有進步的。

關鍵字

呼吸衰竭 ； 高頻振幅呼吸治療 ； 新生兒摶續性肺高壓症 ； 急性呼吸窘迫症候群

並列摘要

A prospective, clinical study was conducted to investigate the factors associated with the effectiveness and outcome of high-frequency oscillatory ventilation (HFOV) in infants with respiratory failure unresponsive to optimal conventional respiratory and pharmacological therapy. A high-lung volume strategy was used in cases with diffuse lung disease. A total of 30 treatments in 24 patients (including 14 premature infants), aged I to 127 days, was included for analysis. By 6 to 8 hours, ＞ 20% improvement in oxygenation (good response) was noted in 57% of treatments, ＜ 20% improvement (poor response) in 20%, 23% showed delayed response 10 to 24 hours after initiation of HFOV. Thirty-five percent of treatments with initial good response deteriorated later because of severe underlying problems or occurrence of ventilatory complications. Seventeen treatments (57%) were weaned successfully to conventional mechanical ventilation (CMV). Poor response was associated with a higher oxygenation index prior to HFOV and a severe underlying problem. Failure to be successfully weaned to CMV was associated with a higher mean airway pressure and a severe underlying condition. Premature infants and infants with the persistent pulmonary hypertension of newborn usually had a good response to HFOV. From results of this study, it is concluded that patients with severe lung disease and a severe underlying problem responded poorly to HFOV. An initial good response did not predict successful weaning.

並列關鍵字

respiratory failure ； high-frequency oscillatory ventilation ； persistent pulmonary hypertension of newborn ； acute respiratory distress syndrome