重症手足口病并神经源性肺水肿目标性救治措施

Targeted Treatment Measures for Children with Severe Hand-Foot-Mouth Disease Complicated with Neurogenic Pulmonary Edema

目的探讨目标性救治措施在重症手足口病(HFMD)并神经源性肺水肿(NPE)患儿抢救中的价值。方法对109例重症HFMD并NPE患儿采用目标性救治进行抢救治疗。1.一般监测和抢救:监测体温、脉搏、呼吸、血压及尿量、血糖、血气和电解质,建立2条以上静脉通路,应用糖皮质激素、利巴韦林、甘露醇和丙种球蛋白等。2.即刻救治阶段:(1)体位:避免胃内容物反流误吸,利于抢救和呼吸道开放;(2)呼吸道与供氧:开放呼吸道保证通气和换气功能,维持经皮氧饱和度>92%,控制肺出血,肺部听诊细湿啰音明显减少;(3)血压:平均动脉压8.66 kPa左右;(4)血糖:4.4～11.0 mmol.L-1;(5)体温:肛温<38.5℃;(6)液体管理:24 h液体量60～80 mL.kg-1,中心静脉压0.588～1.570 kPa;(7)镇痛镇静:人机合拍,刺激后无躁动,无剧咳;(8)血液系统:维持Hb≥10 g.L-1,血细胞比容≥0.30,防治DIC。结果 98例痊愈,7例在NPE期死亡,4例在肺水肿控制后因脑损伤严重家长放弃治疗后死亡,肺水肿期抢救成功率为93.6%,最终抢救成功率为89.9%。结论救治措施目标性方案为HFMD并NPE的救治提供了系统性、可操作性的救治方案,可显著提高其抢救成功率。

Objective To assess the value of targeted treatment measures for children with severe hand-foot-mouth disease（HFMD） complicated with neurogenic pulmonary edema（NPE）.Methods Totally 109 cases of severe HFMD children with NPE were given targeted treatment.1.General monitoring and rescue included monitoring temperature,pulse,respiration,blood pressure and urine output,blood glucose,blood gas and electrolyte,the establishment of 2 or more intravenous access,corticosteroid,ribavirin,mannitol,and gamma globulin.2.Immediate treatment stages：（1） Position：to avoid regurgitation and aspiration of gastric contents,which was helpful for rescue and airway open;（2） Airway and oxygen supply was ensured by ventilation to maintain pulse oxygen saturation92%,and control pulmonary hemorrhage;pulmonary fine wet rales were significantly reduced by auscultation;（3） Mean arterial pressure was maintained around 8.66 kPa;（4）Blood glucose was 4.4-11.0 mmol·L-1;（5）Rectal temperature was 38.5 ℃;（6）Fluid management was kept at 0.588-1.570 kPa for central venous pressure;liquid volume was kept at 60-80 mL·kg-1 per day;（7） Sedation and analgesia was ensured by patient-machine co-operation,without agitation or coughing;（8） Hemoglobin≥10 g·L-1,and haematocrit≥30% was maintained,and disseminated intravascular coagulation was controled.Results Ninety-eight cases were cured,and 7 cases died from neurogenic pulmonary edema,4 cases gave up treatment according to the family members＇ opinion and died due to severe brain damage after the control of pulmonary edema by family members.Survival rate in pulmonary edema was 93.6%,the final survival rate was 89.9%.Conclusion Targeted treatment mea-sures for HFMD with NPE provides a systematic,workable treatment program,which can significantly improve the success rate.