麻疹肺炎并急性呼吸窘迫综合征32例

Clinical Analysis of 32 Children with Measles Complicated with Severe Pneumonia and Acute Respiratory Distress Syndrome

目的探讨麻疹肺炎并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患儿的临床特征和治疗措施。方法收集2004年1月-2007年7月重庆医科大学附属儿童医院PICU收治的32例麻疹肺炎并ARDS患儿的临床资料,对其临床特点进行回顾性分析,同时对死亡组与存活组动脉血氧分压/吸入氧体积分数比值(P/F)、激素治疗组和对照组间病死率进行对比分析。结果32例中好转或治愈16例,死亡16例(包括放弃后死亡的病例),总病死率达50%;死亡组机械通气前P/F比值明显低于存活组[分别为(11.93±1.67)kPa、(21.77±1.16)kPa,P<0.01)];激素治疗组和对照组间病死率分别为40.0%、41.67%,2组比较无显著性差异(P>0.05)。结论ARDS是小儿麻疹肺炎严重并发症,病死率高。P/F比值对ARDS病情严重程度和预后判断有一定参考价值。

Objective To explore the clinical characteristics and the remedial measurement of measles complicated with severe pneumonia and the acute respiratory distress syndrome（ARDS） in children. Methods From Jan 2004 to Jul 2007 .clinical data of 32 cases with measles complicated with severe pneumonia and ARDS in PtCU of Chongqing Children＇s Hospital were retrospective analyzed. In addition ,the ratio of partial pressure of oxygen in arterial blood fraetional concentration of oxygen in inspired gas[pa（O2 ）/Fin2 ] between the death group and survival group ,the mortality rates between the hormone therapy group and control group were performed. Results Sixteen cases were cured and 16 cases were died ,with the mortality rate 50%. The ratio of pa（O2 ） /Fin2 before mechanical ventilation in death gToup was lower than that in the survival group [ （ 11.93±1. 67） kPa, （21.77± 1.16） kPa,respectively,P 〈0.01 ） ]. The mortality rates in the hormone therapy group and control group were 40.0% ,41.67% respectively, there was difference between two groups （ P 〉 0.05 ）. Conclusions ARDS is a severe complication in children with measles pneumonia and associated with a high mortality,which requires early diagnosis and intervention to improve survival rate and prognosis. The ratio ofpa（ O2 ）/Fin2 may provide reference to evaluation for severity and prognosis of ARDS.