hfov (dr vs rajadurai)转载

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1、UPDATEONHIGHFREQUENCYOSCILLATORYVENTILATIONINTHENICU高频振荡通气新动态新加坡竹脚妇幼医院新生儿科主任萨米尔拉惹杜莱医生DrVSRajaduraiSeniorConsultant&HeadofNICUDeptofNeonatologyKKWomen’sandChildren’sHospitalUPDATEONHFOV纲要Background/Introduction简介AnimalStudies动物研究ClinicalManagementStrategies医疗策略

2、ComplicationsofHFOV并发HFOVuseinterminfants用于足月儿HFOVuseinpreterminfants用于早产儿EvidencefromRCTs(CochraneReview)随意对照研究循证HFOV:DEFINITION高频振荡通气定义veryrapidrate(高频率)300-1200BPMsmalltidalvolumesfrequentlylessthandeadspace潮气量通常比死腔来得小activeinspirationandexpiration主动吸气及呼气HF

3、OV:REASONSFORDEVELOPMENT高频振荡通气发展原由1.Toreduceventilatorassociatedlunginjuryby-preventingvolutrauma容量伤-reducingoxygenexposure减低氧气接触-reduceincidenceofCLD减低慢性肺病机率2.Toprovideamethodofassistedventilationthatallowsseverepulmonaryairleakstoheal探寻可治肺气漏的通气的方法DIFFERENCES

4、BETWEENHFOV&CONVENTIONALVENTILATION高频振荡通气与常规机械通气比较CMVHFOVRate(BPM)呼吸频率0-120300-1200TidalVolume潮气量(ml/kg)4-200.1-5Alvpressure肺泡压力(cm/H20)5-500.1-5End-expiratoryLV呼气末压low低high高Expiration呼气passive被动active主动CharacteristicParametersofHFV参数特征GASEXCHANGEDURINGHFOV高频振

5、荡通气的气体交换MECHANISMS机制:Enhancedmoleculardiffusionnearthealveolar-capillarymembrane增进肺气泡－毛细管渗滤Enhancedconvection促进对流(Pendellufteffect摆动效应)Taylordispersion泰勒弥散现象Reduceddependenceonbulkconvection减低对大容积对流依赖Taylor-DispersionIntraalveolarPendelluftTYPESOFHFOVENTILATO

6、RS高频振荡通气呼吸机类型DiaphragmHFOV隔膜型e.g.:SensorMedics3000AIEratio1:2MostpowerfulPistonHFOV活塞泵型e.g.:HummingbirdVariableIEratio1:1-1:2Hybriddevices:混杂型SpinningwheelorventurestogeneratenegativepressuresduringexpirationIEratio1:1e.g.:SLEHFO5000，DragerBabylog8000HFOVDEVIC

7、ES:EFFICACY高频通气器械效能Mechanics,operationandrun-timeadjustmentofthedevicesarequitedifferentNoneofthemaresimilarenoughtobecontrolledinexactlythesamemanner机械功能各异NOhumanstudieshavedirectlycompareddifferenttypesofHFOV仍未有比较用在人类各类高频通气机的研究报告Currently,impossibletosayifon

8、etypeisbetterthantheother目前难说何类型为优HFOV:ANIMALSTUDIES高频通气机的动物研究(1)Lavagedrabbit,lavagedmonkeyprematurebaboon,ReportedBenefits好处是:Decreasedhyalinemembranes减少透明膜Moreuniformlungexpansi