重庆医学2017，Vol.46Issue(1)：57-59,63,4.DOI:10.3969/j.issn.1671-8348.2017.01.012
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
Application of BIPAP ventilation in children patients with severe hand foot and mouth disease complicating neurogenic pulmonary edema
摘要
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.Methods Thirty 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 plat-form (Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure (PaCO2 )and oxygenation index (PaO2/FiO2 )at 0 h (baseline value),24,48,72 h after mechanical ventilation were monitored.Besides,the duration of mechanical ventila-tion,28 d mortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute re-spiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for contin-uous 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 d mortality 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 for 24,48,72 h in 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 pro-vide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.关键词
肺水肿/呼吸,人工/手足口病/通气机,机械/双水平气道正压通气/同步间歇指令通气/神经源性肺水肿Key words
pulmonary edema/respiration,artificial/hand,foot and mouth disease/ventilator,mechanical/bi-level positive air-way pressure ventilation/synchronized intermittent mandatory ventilation/neuronal pulmonary edema分类
医药卫生引用本文复制引用
冼燕珊,周立新,强新华,莫韶妹,曾添辉,马洁葵..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[J].重庆医学,2017,46(1):57-59,63,4.基金项目
广东省科技计划项目（2011B031800373）。 （）
