机械通气辅助治疗在手足口病并发神经源性肺水肿的临床应用

The clinical application value of mechanical ventilation adjuvant therapy on hand, foot and mouth diseases complicated with neurogenic pulmonary edema

目的探讨机械通气辅助治疗在手足口病并发神经源性肺水肿的临床应用价值。方法选取2008至2013年于本院进行治疗的并发神经源性肺水肿的重症手足口病患儿共85例,所有患儿经临床诊断均确诊为重症手足口病并发神经源性肺水肿。将85例患儿按照入院时所处病程进行分组,分为A组、B组和C组三组,分别为28、28和29例患儿。A组28例患儿入院时处于病程第4天,B组28例患儿入院时所处病程第3天,C组29例患儿入院时所处病程第2天,均在内科综合治疗的基础上联合使用机械通气辅助进行治疗。结果经临床治疗,A组、B组和C组患儿分别治愈16例、20例和24例,治愈率分别为57.14%、71.43%和82.76%。C组患儿的治愈率显著高于A组和B组,且差异具有统计学意义(C组vs A组:χ2=16.354、P=0.000,C组vs B组:χ2=4.545、P=0.033)。B组患儿病死率显著低于A组,差异具有统计学意义(χ2=4.583、P=0.032)。C组患儿的高热、口吐白沫、躁动和肺部啰音等临床主要症状的转归时间和住院时间均显著短于B组和A组,且差异具有统计学意义(P均<0.005)。结论机械通气辅助治疗联合内科综合治疗重症手足口病并发神经源性肺水肿患儿,早期应用机械通气辅助治疗能够显著地提高患儿的临床治愈率,并显著地缩短患儿的临床症状持续时间和住院时间,降低病死率,具有较高的临床价值。

Objective To investigate the clinical application value of mechanical ventilation adjuvant therapy on hand, foot and mouth disease （HFMD） complicated with neurogenic pulmonary edema. Methods Total of 85 cases with HFMD complicated with neurogenic pulmonary edema were collected in our hospital from 2008 to 2013. The 85 cases were divided into group A, group B and group C, with 28, 28 and 29 cases, respectively. Group A were in the course of the fourth days, group B were in the course of the third days and the group C were in the course of second days. All cases in the three groups were given the comprehensive treatment of internal department combined with mechanical ventilation. Results Through clinical treatment, there were 16, 20 and 24 cases were cured, the cure rate were 57.14%, 71.43%and 82.76%, respectively. The cure rate of group C were signiifcantly higher than that of group A and group B （group C vs group A：χ2=16.354, P=0.000;group C vs group B：χ^2=4.545, P=0.033）. The mortality of cases in group B was signiifcantly lower than that of group A （χ^2=4.583, P=0.032）. The prognosis time of taking early mechanical ventilation combined with comprehensive treatment of cases in group C in department of internal medicine such as high fever, foaming at the mouth, restlessness and lung rale and the their length of stay were all shorter than that of group B and group A （P all〈0.05）. Conclusions The mechanical ventilation adjuvant therapy combined with neurogenic pulmonary edema treatment of internal department on children with serious HFMD complicated with neurogenic pulmonary edema could signiifcantly enhance the clinical cure rate and shorten the duration of clinical symptoms and length of stay and reduce mortality, which had quite high clinical value.