高PEEP机械通气在危重型手足口病肺出血中的应用

Application of high PEEP mechanical ventilation in the pulmonary hemorrhage of severe hand-foot-mouth disease

目的评价高呼吸末正压(PEEP)机械通气在危重型手足口病肺出血中的应用效果。方法 30例危重型手足口病肺出血患儿,实施高PEEP机械通气对症治疗,观察其效果。结果 30例患儿中24例治疗成功,并在机械通气4 d后符合撤机标准。6例在机械通气8 h后死亡,总抢救成功率为80%。患儿治疗前后血小板计数、血红蛋白比较,差异无统计学意义(P>0.05);治疗后白细胞计数、C反应蛋白、转氨酶、血糖、肌酸激酶、同工酶与治疗前比较,差异有统计学意义(P<0.05)。治疗后,患儿X线胸片示总病变率为20.0%,明显低于治疗前的90.0%,差异有统计学意义(P<0.05)。结论高PEEP机械通气在危重型手足口病肺出血中应用能够显著提高抢救成功率,且患儿肺部出血现象得到明显控制,值得临床推广和应用。

Objective To evaluate the application effect of high positive end-expiratory pressure （PEEP） mechanical ventilation in the pulmonary hemorrhage of severe hand-foot-mouth disease. Methods A total of 30 children with pulmonary hemorrhage of severe hand-foot-mouth disease all received symptomatic treatment of high PEEP mechanical ventilation, and their effect was observed. Results Of 30 children, 24 cases were successfully treated and met the weaning standard 4 days after mechanical ventilation. 6 cases died after 8 h of mechanical ventilation, and the total rescue succ, ess rate was 80%. There was no statistically significant difference in platelet count and hemoglobin before and after treatment （P〉0.05）. After treatment, patients had statisticallysignificant difference in white blood cell count, C-reactive protein, aminotransferase, blood glucose, creatine kinase, isoenzyme, comparing with before treatment （P〈0.05）. After treatment, children had obviously lower total lesion rate by X-ray as 20.0% than 90.0% before treatment, and the difference was statistically significant （P〈0.05）. Conclusion Application of high PEEP mechanical ventilation in pulmonary hemorrhage of severe hand-foot-mouth disease can significantly improve rescue success rate, and the children＇ s pulmonary hemorrhage is obviously controlled. It is worthy of clinical popularization and application.