| 摘要: | 研究目的：使用高頻振盪呼吸器 ( High Frequency Oscillatory Ventilation；HFOV ) 可以減少傳統呼吸器所造成的肺部損傷，並改善急性呼吸窘迫症候群 ( Acute Respiratory Distress Syndrome；ARDS ) 病人之氧合( Oxygenation )狀況。本研究探討成年患者使用 HFOV 效用之影響因子。研究方法：本研究由2006 年1 月至 2010 年 12 月回溯收集南部某醫學中心加護病房成人使用 HFOV 之個案，紀錄病人之性別、年齡、診斷、科別、疾病嚴重度 ( APACHE II ) 、加護病房住院天數、呼吸器使用天數、使用傳統呼吸器與HFOV使用後之呼吸系統參數，並紀錄其存活與否。統計分析方法，係採用 SPSS for windows 17.0 ( An IBM Company ) 軟體，先描述性統計病人基本資料，再利用卡方檢定及無母數之 Wilcoxon 等級和檢定 ( Wilcoxon rank sum test )，比較生存者與非生存者之差異。利用無母數之 Wilcoxon 等級符號檢定 ( Wilcoxon signed rank test ) 分析 HFOV 使用前後氣體交換與呼吸系統參數之差異。利用二元邏吉斯迴歸分析影響病人死亡率的風險因子。研究結果：本研究共收集 77 位病人資料，其使用 HFOV 後 72 小時內之 FiO2 、P/F ratio、 pH 、 PaCO2 皆呈統計顯著改善 ( P<0.05 ) 。平均氣道壓力( Mean airway pressure；mPaw ) 亦顯著地提高；存活者與非存活者之年齡 ≧60 歲 ( 35% VS 64.9%, P<0.05 ) 、 HFOV 使用時數 ( 129.8 ± 79.7 VS 99.6 ± 128.1, P<0.05 ) 、平均動脈壓 ( 91.7 ± 20 VS 80.1 ± 19.3, P<0.05 )都呈顯著差異。存活者與非存活者使用 HFOV 前的各項差異，非存活者血液 pH 值在 HFOV 使用後較存活者顯著偏低 ( 7.34 ± 0.09 VS 7.28 ± 0.12 P<0.05 ) 。至於 mPaw 、 FiO2 、 PaCO2 與 Oxygenation Index 二組間，則無明顯差異 。結論與建議：HFOV對於改善成年病人的氣體交換功能確實有幫助，可增加 P/F ratio 與pH 值，降低氧氣的使用濃度 ( FiO2 ) 與 PaCO2 ，且效果在 HFOV 使用24小時，達到高峰，直到 72小時都能維持其功效。使用 HFOV前之氣體交換功能較佳者，預後也較好，表示在疾病早期使用 HFOV，可得到較佳的結果。
Purpose： High frequency oscillatory ventilator (HFOV) reduces lung injury from conventional ventilation and improves oxygenation in patients with acute respiratory distress syndrome (ARDS). The purpose of this study is to investigate factors influencing the effectiveness of HFOV in adult patients.Method：We performed a retrospective study on adult patients, who was treated with HFOV during January 2006 to December 2010, hospitalized in ICU of a medical center in southern Taiwan. The information of gender, age, diagnosis, ICU admission type, APACH II, days of ICU stay, ventilator days were collected. Additionally, the survival of patients, parameters of respiratory system between conventional mechanical ventilation and HFOV were compared using SPSS 17.0 for windows (An IBM Company). In the first part, we used descriptive statistics to analyze background information of patients. Continueously, we used chi-square and the Nonparametric Wilcoxon rank sum test to compare the differences of factors between survivors and non-survivors. The respiratory gas exchange and the parameters of respiratory system before and after using HFOV were analyzed by the nonparametric Wilcoxon signed rank test. The risk factors for mortality were calculated by multiple logistic regression analysis. Result：The data of study were collected from 77 patients. The improvement (P<0.05) of FiO2, P/F ratio, pH, and PaCO2 in ARDS patients was observed significantly within 72 hours after treating with HFOV. The mean airway pressure (mPaw) was increased significantly, respectively. The significant differences was showed in patients ≧60 years (35% vs. 64.9%,P<0.05),HFOV hours (129.8±79.7 vs. 99.6±128.1, P<0.05), mean arterial pressure (91.7±20 vs. 80.1±19.3 mm Hg, P<0.05) between survivors and non-survivors. Furthermore, the pH level of non-survivors after treating with HFOV was significantly lower than survivors (7.34±0.09 vs. 7.28±0.12, P <0.05). however, There is no significant difference in mPaw, oxygen concentration (FiO2), PaCO2, and Oxygenation index between the two groups. Conclusion：HFOV improved gas exchange and increased the P/F ratio and pH level in adult patients. Furthermore, levels of FiO2 and PaCO2 were decreased in ARDS patients, respectively. The efficiency of HFOV peaked at 24 hours and remained constant through 72 hours. Patients with better pulmonary gas exchange before HFOV treated had better prognosis, indicating that early HFOV treated was associated with better outcomes. |
