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  

Clinical efficiency of noninvasive or invasive positive pressure ventilation in treating severe hand foot and mouth disease with pulmonary edema

作　　者：徐南平[1] 葛励强 章武强[1] 刘洪[1] 朱庆雄[1] 朱友荣[1] 

机构地区：[1]江西省儿童医院急诊中心,江西南昌330006

出　　处：《中国急救医学》2015年第8期706-711,共6页Chinese Journal of Critical Care Medicine

基　　金：江西省卫生厅重大科技项目（20114018）

摘　　要：目的：探讨无创与有创正压通气对防治重症手足口病神经源性肺水肿（ NPE）的疗效分析。方法选择2011－05-2014－04入住我院的重症手足口病患者（2、3期）228例，分为对照组（2期）70例，按照常规治疗；经鼻持续正压气道通气（ CPAP）组108例，常规治疗基础上加简易经鼻持续气道正压通气；呼吸机组50例，常规治疗的基础上加有创机械通气。结果2期CPAP组与对照组及呼吸机组（2期）的治愈好转率比较差异无统计学意义（P＝0．26，0．156）；3期呼吸机组的病程较CPAP组短（P＝0．000），但呼吸机组的血糖水平高于CPAP组，两组比较差异有统计学意义（ P＝0．05）；3期呼吸机组进展到4期的有8例均合并NPE明显高于3期CPAP组（ P＝0.004），5例死于肺出血，病死率62.5％，3期呼吸机组的最终病死率高于CPAP组（ P＜0.01）。结论目前没有临床依据推荐在2期重症手足口病常规使用机械通气；经鼻持续气道正压通气对3期危重症手足口病的症状改善、阻止病情进展、防治神经源性肺水肿及在减少有创机械通气使用方面具有肯定的疗效与优势。Objective To investigate the efficacy of noninvasive or invasive positive pressure ventilation in treatment of severe hand foot and mouth disease （ HFMD ） with pulmonary edema. Methods A total of 228 patients with severe HFMD hospitalized in emergency ward and PICU of Children＇s Hospital of Jiangxi Province between May 2011 and April 2014 were involved in the present study.The patients were divided into three groups：the control group （ n=70 ） , the CPAP group （ n=108）, which on the basis of conventional therapy plus simple nasal continuous positive airway pressure, the ventilation group （ n =50 ） , on the basis of conventional therapy plus invasive mechanical ventilation.Results The total efficiency rate of the stage 2 of CPAP group compared with the control group and ventilation group were not significantly different （ P =0.26, 0.156）.The hospitalization duration in the stage 3 of CPAP groups （4.5 ±1.8） days was higher than that of ventilation groups （2.3 ±1.8）days, which were significantly different （P=0.000）.The blood glucose （9.8 ±4.1） mmol/L of the stage 3 of ventilation groups was significantly higher than that of CPAP groups [（7.4 ± 2.2）mmol/L, P=0.05].Eight patients in grade 3 of the ventilation group developed to grade 4, these 8 cases were complicated with pulmonary edema, which were （8/40, 20%） significantly higher than those （0/38, 0, P =0.004） of the CPAP group, and 5 cases died of pulmonary hemorrhage, the mortality rate was 62.5%.Therefore the mortality was significantly higher in stage 3 of the ventilation group （5/40, 12.5%） than that of the CPAP group （0/38, 0, P=0.001）.Conclusion There is no clinical evidence to recommend use of mechanical ventilation routinely in stage 2 of severe HFMD.＆amp;nbsp;Noninvasive positive pressure ventilation may be more advantages in improving symptoms, preventing disease progression, preventing pulmonary edema and reducing the use of invasive ventilation for the stage 3 of severe HFMD.

关 键 词：手足口病 有创正压通气 无创正压通气 肺水肿 Hand FOOT and MOUTH disease(HFMD) 

分 类 号：R651.15[医药卫生—外科学]