小潮气量机械通气对重症手足口病合并神经源性肺水肿患儿转归的影响

摘要/Abstract

摘要： 目的观察小潮气量机械通气对重症手足口病（HFMD）合并神经源性肺水肿（NPE）患儿转归的影响。方法将80例HFMD合并NPE患者随机分为对照组和观察组,每组40例;对照组给予传统潮气量（10~12ml/kg）机械通气,观察组给予小潮气量（6~8ml/kg）机械通气,比较两组机械通气24h血气分析指标pH、动脉血氧分压（PaO₂）、二氧化碳分压（PaCO₂）、上机时间、吸氧时间、ICU停留时间、住院时间、并发症发生率以及远期转归情况。结果机械通气24h后,观察组pH显著低于对照组（P<0.05）,观察组PaCO₂显著高于对照组（P<0.05）,两组PaO₂比较差异无统计学意义（P>0.05）;观察组上机时间、吸氧时间、ICU停留时间、住院时间均显著短于对照组（P<0.05）;观察组呼吸机相关性肺损伤（VALI）发生率及危重症转化率均显著降低,差异有统计学意义（P<0.05）;观察组远期转归情况优于对照组（P<0.05）。结论 HFMD合并NPE患儿实施小潮气量机械通气有助于缩短机械通气时间、ICU停留时间,并降低VALI发生率及危重症转化率。

关键词: 重症手足口病, 神经源性肺水肿, 小潮气量机械通气, 转归

Abstract: Objective To observe the effect of low tidal volume mechanical ventilation on outcomes of children with severe hand foot mouth disease (HFMD) complicated with neurogenic pulmonary edema (NPE). Methods 80 children with HFMD complicated with NPE were randomly divided into control group and observation group, 40 children in each group. The control group was given conventional tidal volume (10~12ml/kg) mechanical ventilation while the observation group was given low tidal volume (6~8ml/kg) mechanical ventilation. Blood gas analysis indexes pH, arterial partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), time of ventilation, time of oxygen inhaling, length of ICU stay, hospitalization time, incidence of complications and long-term outcome were compared between the two groups after 24h of mechanical ventilation. Results After 24h of mechanical ventilation, the pH of observation group was significantly lower than that of control group (P<0.05), and the PaCO₂ in observation group was significantly higher than that in control group (P<0.05). There was no significant difference between the two groups in PaO₂ (P>0.05). The time of ventilation, time of oxygen inhaling, length of ICU stay and hospitalization time of observation group were significantly shorter than those of control group (P<0.05). The incidence of ventilator associated lung injury (VALI) and the conversion rate of critical illness in observation group were obviously lower than those in control group (P<0.05). The long-term outcome of observation group was better than that of the control group (P<0.05). Conclusion The application of low tidal volume mechanical ventilation in children with HFMD complicated with NPE helps to shorten the time of mechanical ventilation and length of ICU stay, and reduce the incidence of VALI and conversion rate of critical illness.

Key words: hand-foot-mouth disease, neurogenic pulmonary edema, low tidal volume mechanical ventilation, outcome

中图分类号:

R725

韩传映. 小潮气量机械通气对重症手足口病合并神经源性肺水肿患儿转归的影响[J]. 承德医学院学报, 2020, 37(6): 469-471.

HAN Chuan-ying. Effect of Low Tidal Volume Mechanical Ventilation on Outcomes of Children with Severe HFMD Complicated with Neurogenic Pulmonary Edema[J]. Journal of Chengde Medical University, 2020, 37(6): 469-471.

参考文献

[1] 张泽武,黄雪华,杨庆东,等. 手足口病危险因素的meta分析[J]. 中国卫生统计,2015,32(1):112-114.
[2] 廖玉学,路滟,梅树江,等. 2009-2013年深圳市手足口病流行特征分析[J]. 实用预防医学,2015,22(1):69-71.
[3] 孙杰,张小坤. 机械通气治疗重症手足口病221例临床分析[J]. 重庆医学,2015,44(1):101-103.
[4] 中华人民共和国卫生部. 手足口病诊疗指南(2010版)[J]. 中国实用乡村医生杂志,2012,19(19):9-11.
[5] 中华人民共和国卫生部. 手足口病预防控制指南(2009版)[J]. 中国实用乡村医生杂志,2012,19(19):6-8.
[6] 张斯钰,黄威,罗垲炜,等. 2010-2013年湖南省手足口病病原学监测结果分析[J]. 现代预防医学,2015,42(9):1677-1679.
[7] 王林霞,王敏,汤鲁明,等. 小剂量吗啡在重症手足口病患儿机械通气中的应用研究[J]. 中华全科医学,2016,14(04):595-597.
[8] 徐南平,葛励强,章武强,等. 无创与有创正压通气防治重症手足口病神经源性肺水肿的疗效分析[J]. 中国急救医学,2015,35(8):706-711.
[9] 蔡克俭,蔡艳芳,刘端,等. 小潮气量和传统潮气量机械通气在急性低氧性呼吸衰竭患儿治疗中的安全性差异[J]. 河北医药,2017,39(16):2508-2510.
[10] Krebs J, Tsagogiorgas C, Pelosi P, et al.Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage[J]. Critical Care, 2014, 18(2): 59-60.
[11] 张欣,赵子平,刘宁. 急性呼吸窘迫综合征小潮气量肺保护通气策略的预后分析[J]. 内科急危重症杂志,2015,21(2):120-121.
[12] 沈彤,刘成军,刘茂花,等. 小剂量糖皮质激素联合小潮气量、肺复张在重症肺炎肺损伤患儿中的应用[J]. 儿科药学杂志,2016,22(7):8-10.

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