地塞米松减轻机械通气患儿拔管后喉水肿研究

Study on Dexamethasone on Lightening the Laryngeal Edema After Extubation in Children with Mechanical Ventilation

目的研究地塞米松对于机械通气患儿拔管后喉水肿及再插管率的影响。方法回顾性分析我院在2012年6月至2015年6月间收治的、年龄在1个月-4岁之间、插管时间至少24 h的所有PICU患儿的病历资料,比较在拔管前预防使用地塞米松组（n=87）与对照组（n=211）喉水肿及再插管率的差异。结果地塞米松组喉水肿发生率为11.5%（10/87）,显著低于对照组的22.3%（47/211）,差异有统计学意义（P〈0.05）。地塞米松组再插管率为1.1%（1/87）,显著低于对照组的6.6%（14/211）,差异有统计学意义（P〈0.05）。结论对于高危患儿,拔管前预防性使用地塞米松可降低拔管后喉水肿及再插管率;对于插管时间超过24 h的高危患儿可考虑预防性使用地塞米松。

Objective To study the effect of dexamethasone on laryngeal edema after extubation in children with mechanical ventilation and re-intubation rate. Methods The clinical data of PICU patients aged from 1 month to 4 years old with intubation for at least24 h were analyzed retrospectively. All cases were divided into two groups： dexamethasone group（n = 87, preventive use of dexamethasone）, and control group（n = 211）. The incidence rate of laryngeal edema and re-intubation rate were observed and compared between the two groups. Results The incidence rate of laryngeal edema in dexamethasone group was 11.5%（10/87）, significantly lower than 22.3%（47/211） in control group（P〈0.05）. The rate of re-intubation in dexamethasone group was 1.1%（1/87）, significantly lower than6.6%（14/211） in control group（P〈0.05）. Conclusions Preventive use of dexamethasone before extubation for children with high risk can reduce the incidence of laryngeal edema and re-intubation. Preventive use of dexamethasone will be considered in children with intubation for more than 24 h.