负压性肺水肿四例临床分析  

Clinical analysis of 4 children with negative pressure pulmonary edema

作　　者：陈杰华[1] 王姝 马红玲[1] 王文建[1] 付丹[3] 黄文献[1] 邓继岿[1] 唐辉英[1] 何颜霞[4] 郑跃杰[1] 

机构地区：[1]深圳市儿童医院呼吸科,518026 [2]深圳市第六人民医院儿科 [3]深圳市儿童医院急诊科,518026 [4]深圳市儿童医院重症监护室,518026

出　　处：《中华儿科杂志》2014年第2期122-127,共6页Chinese Journal of Pediatrics

摘　　要：目的 分析负压性肺水肿（NPPE）的临床特点.方法 对2012年6月-2013年7月深圳市儿童医院收治的4例NPPE患儿的临床表现、影像学等检查、治疗经过、转归及气道梗阻病因进行回顾性总结分析.结果 4例患儿均为男性,年龄40 d ～9岁,既往无严重呼吸及循环系统病史.4例中3例在气道梗阻后数分钟、1例在梗阻解除后1.5h出现气促、呼吸困难、发绀等症状,无发热.3例肺部听诊闻及粗湿啰音,1例无啰音.3例胸部X线平片、1例胸部CT检查均提示双肺磨玻璃样改变,可见斑片状浸润影.3例患儿入住ICU,机械通气时间：2例＜24 h,1例39 h后撤机,症状好转.另1例经吸氧对症治疗10 h后症状消失.所有病例均未使用利尿剂、糖皮质激素和强心药.2例治疗后24 h、2例24 ～ 48 h复查胸X线片病灶明显吸收.所有病例痊愈出院.气道梗阻病因：气道异物2例,喉痉挛1例,喉软化1例.结论 NPPE是一种潜在危及生命的急症,表现为气道梗阻解除后不久（也可在数小时后）突然出现呼吸窘迫症状,影像学肺水肿改变,经及时吸氧、机械通气等呼吸支持治疗病情可很快好转.临床上气道梗阻时应警惕NPPE.Objective To analyze the clinical characteristics of negative pressure pulmonary edema （NPPE）.Method A retrospective investigation of the clinical manifestation,imageology,clinical course and outcome of 4 children with NPPE seen between June 2012 and July 2013 in a children＇s hospital.The causation of the airway obstruction was also explored.Result All the 4 cases were boys,the range of age was 40 days to 9 years.They had no history of respiratory and circulatory system disease.In 3 cases the disease had a sudden onset after the obstruction of airway,and in one the onset occurred 1.5 hours after removing the airway foreign body.All these cases presented with tachypnea,dyspnea,and cyanosis,none had fever.Three cases had coarse rales.Chest radiography was performed in 3 cases and CT scan was performed in 1 case,in all of them both lungs displayed diffuse ground-glass-like change and patchy consolidative infiltrates.Three cases were admitted to the ICU,duration of mechanical ventilation was less than 24 hours in 2 cases and 39 hours in one.Oxygen was given by mask to the remaining one in emergency department,whose symptoms were obviously improved in 10 hours.None was treated with diuretics,glucocorticoids or inotropic agents.Chest radiographs were taken within 24 hours of treatment in 2 cases and 24-48 hours in the other 2 ; almost all the pulmonary infiltrates were resolved.All the 4 cases were cured.The causes of airway obstruction were airway foreign bodies in two cases,laryngospasm in one and laryngomalacia in the other.Conclusion NPPE is a life-threatening emergency,which is manifested by rapid onset of respiratory distress rapidly （usually in several minutes,but might be hours later） after relief of the airway obstruction,with findings of pulmonary edema in chest radiograph.The symptoms resolve rapidly by oxygen therapy timely with or without mechanical ventilation.In children with airway obstruction,NPPE should be considered.

关 键 词：负压性肺水肿 梗阻后肺水肿 气道梗阻 气道异物 喉痉挛 喉软化 

分 类 号：R725.6[医药卫生—儿科]