BIPAP通气在重症手足口病合并神经源性肺水肿患儿救治中的应用

发布时间：2018-11-26 19:03

【摘要】：目的探讨双水平气道正压(BIPAP)通气与同步间歇指令(SIMV)通气两种不同的机械通气模式对于重症手足口病合并神经源性肺水肿患儿呼吸功能及临床疗效的影响。方法将30例接受机械通气的重症手足口病合并神经源性肺水肿患儿分为SIMV组(对照组)及BIPAP组(试验组),两组患儿均采用肺保护性通气策略,使用SIMV加用呼气末正压(PEEP)通气30min后,试验组改用BIPAP通气模式,对照组仍使用初始参数,监测患儿接受机械通气0h(基础值),24、48、72h时的气道峰压、肺泡平台压(Pplat)、肺顺应性、pH值、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、机械通气时间、28d病死率及住重症医学科(ICU)时间。结果 30例患儿均平稳度过了急性呼吸衰竭期,两组各有1名患儿在治疗后期转院继续治疗,其中对照组转院的患儿最终放弃治疗死亡,其余28例患儿均临床治愈出院,两组患儿的28d病死率分别为6.67%、0%,比较差异无统计学意义(P0.05)。与对照组比较,试验组在机械通气24、48、72h后,患儿的气道峰压、Pplat、PaCO2显著下降(P0.05);肺顺应性及PaO2/FiO2改善明显高于对照组(P0.05);同时机械通气时间及住ICU时间较对照组短(P0.05)。结论 BIPAP模式用于重症手足口病合并神经源性肺水肿患儿的机械通气治疗,能提供更好的有效通气,改善氧合及呼吸功能,缩短其机械通气时间。
[Abstract]:Objective to investigate the effects of two different mechanical ventilation modes of bi-level positive airway pressure (BIPAP) ventilation and synchronous intermittent mandatory (SIMV) ventilation (SIMV) on respiratory function and clinical efficacy in children with severe hand-foot-mouth disease (HFMD) complicated with neurogenic pulmonary edema (NPE). Methods Thirty children with severe HFMD complicated with neurogenic pulmonary edema received mechanical ventilation were divided into SIMV group (control group) and BIPAP group (experimental group). After using SIMV plus positive end-expiratory pressure (PEEP) to ventilate 30min, the experimental group changed to BIPAP ventilation mode, while the control group still used initial parameters. The children received mechanical ventilation for 0 h (base value), the peak airway pressure at 24 minutes 48 hours, and the alveolar plateau pressure (Pplat), for 72 hours. Pulmonary compliance, pH, arterial blood carbon dioxide partial pressure (PaCO2), oxygenation index (PaO2/FiO2), mechanical ventilation time, fatality rate of 28 days and (ICU) time in intensive care department. Results all the 30 cases had passed the acute respiratory failure smoothly. One child in each group was transferred to hospital in the later stage of treatment. The control group finally gave up the treatment and died. The other 28 cases were cured and discharged. The fatality rate of 28 days in the two groups was 6.67. The difference was not statistically significant (P0.05). Compared with the control group, the peak airway pressure and Pplat,PaCO2 in the experimental group were significantly lower than those in the control group (P0.05), the improvement of lung compliance and PaO2/FiO2 were significantly higher in the experimental group than in the control group (P0.05). At the same time, the time of mechanical ventilation and residence of ICU was shorter than that of control group (P0.05). Conclusion BIPAP model can provide better ventilation, improve oxygenation and respiratory function, and shorten the time of mechanical ventilation in children with severe hand, foot and mouth disease combined with neurogenic pulmonary edema.
【作者单位】：广东省佛山市第一人民医院重症医学科;
【基金】：广东省科技计划项目(2011B031800373)
【分类号】：R725

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