儿童重症监护室的麻疹患儿呼吸道严重并发症分析

Analysis of serious respiratory complications in PICU in children with measles

目的 分析入住儿童重症监护室（PICU）的麻疹患儿严重并发症的特点.方法 回顾性分析安徽省儿童医院PICU 2012年5月至2013年5月收住的17例出现严重并发症的麻疹患儿,分析17例患儿的临床资料、影像学改变和转归情况.17例患儿中男9例、女8例,年龄2个月至10岁,均为血清学检测麻疹IgM抗体阳性患儿.结果 17例患儿在起病1周内因严重呼吸窘迫给予机械通气,其中14例并发急性呼吸窘迫综合征（ARDS）,张力性气胸6例,3例并发喉气管支气管炎,喉梗阻Ⅲ度以上,共死亡7例.存活的10例患儿随访1年,1例包裹性气胸＋支气管胸膜瘘,1例轻度肺纤维化,1例喉炎患儿持续存在声嘶,轻度吸气性呼吸困难.余7例完全康复.14例未接种麻疹疫苗.结论 需人住PICU的麻疹患儿有较高的死亡风险和较差的转归,尤其是ARDS合并气胸;喉炎治疗时间长,撤机困难,有包裹性积液、支气管胸膜瘘的须手术治疗,且易继发细菌感染.

Objective To evaluate the characteristics of the serious complications of 17 cases with measles in ICU.Method Seventeen cases with measles with serious complications in ICU in Anhui Provincial Children＆#39;s Hospital were recruited from May 2012 to May 2013.Clinical characteristics,image finding,and prognosis were analyzed retrospectively.IgM antibody was positive in all the 17 cases,which included 9 male cases,8 female cases,and their age was from 2 months to 10 years.Result All the 17 patients received mechanical ventilation because of severe respiratory distress within 1 week of onset,of which 14 cases were complicated with acute respiratory distress syndrome （acute ARDS）,6 cases of tension pneumothorax,3 cases were complicated with bronchitis,laryngeal obstruction Ⅲ degrees,and totally 7 cases died.The survived 10 patients were followed up for 1 year,1 patient with localized pneumothorax,bronchopleural fistula,1 case of mild pulmonary fibrosis,1 case of acute laryngitis with persistent hoarseness,and mild inspiratory dyspnea were found.The remaining 7 cases fully recovered.Fourteen cases failed to inoculate measles vaccine.Conclusion A higher risk of death and poor prognosis were found in children with measles who needed to be treated in PICU,especially for ARDS with pneumothorax.Laryngitis needed long time to cure and had weaning difficulties,and the case associated with pleural effusion or bronchopleural fistula must be treated with surgery,and the patients easily develop secondary bacterial infection.