【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(P>0.05)。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(P<0.05);肺顺应性及PaO2/FiO2改善明显高于对照组(P<0.05);同时机械通气时间及住ICU时间较对照组短(P<0.05)。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。更多还原

【Abstract】 Objective To investigate the influence of two different mechanical ventilation modes of bi-level positive airway pressure ventilation(BIPAP)and synchronized intermittent ventilation(SIMV)on the respiratory function and clinical curative effect in children patients with severe hand foot and mouth disease(HFMD)complicating neurogenic pulmonary edema.MethodsThirty children patients with severe HFMD complicating neurogenic pulmonary edema receiving mechanical ventilation were divided into the SIMV group(control group)and BIPAP group(experimental group).The lung protective ventilation strategy was applied in both groups.After 30 min use of SIMV and positive end expiratory pressure(PEEP)ventilation,the experimental group changed to use the BIPAP ventilation mode,while the control group still used the initial parameters.The airway peak pressure,alveolar platform(Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure(PaCO2)and oxygenation index(PaO2/FiO2)at 0h(baseline value),24,48,72 hafter mechanical ventilation were monitored.Besides,the duration of mechanical ventilation,28 dmortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute respiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for continuous therapy.Among them the transferred case in the control group finally died due to give up treatment.The rest 28 cases all were cured and discharged from hospital.The 28 dmortality rates in the two groups were 6.67%and 0%respectively,with no statistical difference(P>0.05).Compared with the control group,the airway peak pressure,Pplat and PaCO2 after mechanical ventilation for24,48,72 hin the experimental group were significantly decreased(P<0.05);the lung compliance and PaO2/FiO2 improvement was significantly higher than that in the control group(P<0.05);meanwhile the duration of mechanical ventilation and the length of ICU stay in the experimental group were shorter than those in the control group(P<0.05).Conclusion The BIPAP mode used in the mechanical ventilation therapy of the children patients with severe HFMD complicating neurogenic pulmonary edema can provide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.更多还原