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  

Effect of Low Tidal Volume Mechanical Ventilation on Outcomes of Children with Severe HFMD Complicated with Neurogenic Pulmonary Edema

作　　者：韩传映[1] HAN Chuan-ying(Luohe Central Hospital,Luohe Henan,462000,China)

机构地区：[1]漯河市中心医院,河南漯河462000

出　　处：《承德医学院学报》2020年第6期469-472,共4页Journal of Chengde Medical University

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p H、动脉血氧分压(Pa O2)、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p H显著低于对照组(P<0.05),观察组Pa CO2显著高于对照组(P<0.05),两组Pa O2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。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(10~12 ml/kg)mechanical ventilation while the observation group was given low tidal volume(6~8 ml/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 24 h of mechanical ventilation.Results After 24 h 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.

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 

分 类 号：R725[医药卫生—儿科]