小儿急性肺出血诊治体会

Experience of diagnosis and treatment on children acute pulmonary hemorrhage

目的探讨小儿急性肺出血病因、发病机制、临床特点及其治疗方法。方法对21例肺出血小儿进行以机械通气为主的综合治疗,并回顾性分析其临床资料。结果经积极治疗21例肺出血小儿存活12例(57%),死亡8例(38%),最终放弃1例。感染性疾病引起的肺出血16例,占本组首位。全部患儿均给予同步间歇指令通气(SIMV)加呼气末正压通气(PEEP)治疗,吸气峰压(PIP)为(28.5±4.3)cmH2O,PEEP为(7.2±1.6)cmH2O,吸气时间Ti(0.92±0.37)s,肺出血后平均机械通气时间为(32.8±7.4)h,平均出血停止时间为(18.5±11.8)h,平均住院时间为13.6d。结论机械通气是小儿肺出血抢救成功的主要措施,维持循环功能稳定,补充血因子,适当提高呼气末正压和峰压,延长吸气时间,可提高治疗效果。

Objective To investigate the etiology of acute pulmonary hemorrhage,pathogenesis,clinical features and treatment methods.Methods 21 cases of pulmonary hemorrhage in children with mechanical ventilation comprehensive treatment,and clinical data were retrospectively analyzed.Results The active treatment of 21 cases survived 12cases of pulmonary hemorrhage in children（57%）,8 patients died（38%）and finally one case given up.Infectious disease caused by pulmonary hemorrhage in 16 cases,representing the first group.All patients correspondingly synchronized intermittent mandatory ventilation（SIMV）plus end expiratory pressure（PEEP）therapy,peak inspiratory pressure（PIP）to（28.5±4.3）,PEEP was（7.2±1.6）cmH2O,inspiratory time（0.92±0.37）s.Pulmonary hemorrhage average time of mechanical ventilation（32.8±7.4）h,the average time for bleeding to stop（18.5±11.8）h,the average hospital stay was 13.6 days.Conclusions Mechanical ventilation is a successful treatment of pulmonary hemorrhage in maintaining the children＇s circulatory function and stability,added coagulation factor,an appropriate increase of PEEP and peak pressure,inspiratory time extension,can improve the therapeutic effect.