危重症手足口病患儿早期机械通气时机的选择  

Early Use Mechanical Ventilation for Critical Cases of Hand-Foot-Mouth Disease

作　　者：武海滨[1] 王义[1] 邓慧玲[1] 文金全[1] 孙宏利[1] 安媛[1] 王娟[1] 

机构地区：[1]西安市儿童医院,陕西西安710003

出　　处：《医学临床研究》2015年第7期1258-1261,共4页Journal of Clinical Research

基　　金：陕西省科学技术研究发展项目（201IK12-82）;西安市卫生局科技项目（J2011028）;西安市科学技术局医疗卫生研究项目（SF1208）;国家科技重大专项《病毒性传染病病原谱流行规律及变异研究》（2013ZX10004202）

摘　　要：【目的】探讨手足口病（HFMD）危重症早期机械通气的时机选择，以合理把握时机，降低危重症HFMD的病死率及致残率和避免过度医疗。【方法】选择本院感染科ICU收治2012年5月至2014年12月符合我国卫生部《手足口病诊疗指南2010年版》标准，并按照《肠道病毒71型（EV71）感染重症病例临床救治专家共识（2011年版）》条例应用机械通气治疗的123例患儿的临床资料进行回顾性分析；123例中男75例，女48例；发病年龄3个月至4．4岁，平均（1．89±1．04）岁；将病例按照机械通气时气道分泌物的状况分为两组。A组：插管时已有口鼻分泌物溢出，B组插管时仅咽部有分泌物溢出。对两组病例的症状、体征、血糖、氧合指数、住院天数、机械通气时间、预后的资料进行比较分析。【结果】A、B组病例氧合指数（283．59±67，155．19±40．70）相差128．4；机械通气时间（9．50±4．10，6．21±2．44）d、相差3．2d；住院时间（16．21±4．4，13．28±2．09）d，相差2．9d；治愈好转率（66．53％，89．13％）相差23．4％，B组氧合指数、机械通气时间、平均住院日、治愈好转率等指标均明显优于A组，且两组相比较差异有显著性（P〈0．01）。【结论】危重症HFMD患儿在中枢神经受损早期当咽部有分泌物时及应进行机械通气，从而可以明显降低患儿病死率和治疗成本。[Objective] To explore the clinical characteristics of children with critical hand-foot-mouth disease （HFMD） on mechanical ventilation so as to reduce the mortality and disability rates and avoid excessive medical care. [Methods] A total of 123 children With critical HFMD were admitted into intensive care unit between May 2012 and December 2014 according to the Diagnosis ＆ Treatment Guidelines of Hand, Foot and Mouth Disease, 2010. And mechanical ventilation was initiated according to the Expert Consensus on Clinical Control of Severe Enterovirus 71 （EV71） Infection, 2011）1. Their clinical data were retrospectively analyzed. There were 75 boys and 48 girls with a mean age of 1.89±1.04 （0.25±4） years. Base upon the presence of airway secretions during mechanical ventilation, they were divided into group A （nose and mouth secretion during intubation） and group B （pharyngeal secretion during intubation）. Their symptoms, signs, blood glucose, oxygenation index, hospitalization duration, mechanical ventilation time and prognosis Of two groups are compared by statistical software. [Results] The discrepancy in oxygenation index （283. 59 ± 67, 155. 19 ± 40.70） was 128.4, time of mechanical ventilation （9. 50±4. 10, 6.21±2.44） 3.2 days, length of hospital stay （16.21±4.4, 13.28±2.09） 2.9 days and curative rate （66.53%, 89.13%） 23.4G. The oxygenation index, mechanical ventilation time, hospitalization duration and curative rate were significantly better in group B than those in group A. And there were significant inter-group differences （ P 〈0.01）. [Conclusion] Children of critical HFMD with central nerve injury should receive early mechanical ventilation in case of pharyngeal secretion. And it may significantly reduce mortality and treatment costs.

关 键 词：手足口病 危重病 呼吸 人工 回顾性研究 

分 类 号：R725.125.7[医药卫生—儿科]