【摘要】：目的探討雙水平氣道正壓(BIPAP)通氣與同步間歇指令(SIMV)通氣兩種不同的機(jī)械通氣模式對于重癥手足口病合并神經(jīng)源性肺水腫患兒呼吸功能及臨床療效的影響。方法將30例接受機(jī)械通氣的重癥手足口病合并神經(jīng)源性肺水腫患兒分為SIMV組(對照組)及BIPAP組(試驗組),兩組患兒均采用肺保護(hù)性通氣策略,使用SIMV加用呼氣末正壓(PEEP)通氣30min后,試驗組改用BIPAP通氣模式,對照組仍使用初始參數(shù),監(jiān)測患兒接受機(jī)械通氣0h(基礎(chǔ)值),24、48、72h時的氣道峰壓、肺泡平臺壓(Pplat)、肺順應(yīng)性、pH值、動脈血二氧化碳分壓(PaCO2)、氧合指數(shù)(PaO2/FiO2)、機(jī)械通氣時間、28d病死率及住重癥醫(yī)學(xué)科(ICU)時間。結(jié)果 30例患兒均平穩(wěn)度過了急性呼吸衰竭期,兩組各有1名患兒在治療后期轉(zhuǎn)院繼續(xù)治療,其中對照組轉(zhuǎn)院的患兒最終放棄治療死亡,其余28例患兒均臨床治愈出院,兩組患兒的28d病死率分別為6.67%、0%,比較差異無統(tǒng)計學(xué)意義(P0.05)。與對照組比較,試驗組在機(jī)械通氣24、48、72h后,患兒的氣道峰壓、Pplat、PaCO2顯著下降(P0.05);肺順應(yīng)性及PaO2/FiO2改善明顯高于對照組(P0.05);同時機(jī)械通氣時間及住ICU時間較對照組短(P0.05)。結(jié)論 BIPAP模式用于重癥手足口病合并神經(jīng)源性肺水腫患兒的機(jī)械通氣治療,能提供更好的有效通氣,改善氧合及呼吸功能,縮短其機(jī)械通氣時間。
[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.
【作者單位】： 廣東省佛山市第一人民醫(yī)院重癥醫(yī)學(xué)科;
【基金】：廣東省科技計劃項目(2011B031800373)
【分類號】：R725

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