危重型手足口病患儿选择机械通气治疗时机分析

Analysis on the timing of mechanical ventilation in critically ill children with hand-foot-mouth disease

目的探讨手足口病(HFMD)危重症机械通气的时机选择以合理把握时机,降低危重症HFMD的病死率及致残率和避免过度医疗。方法选取我院感染科ICU在2015年12月~2016年12月期间收治的应用机械通气治疗的120例患儿,将其按照机械通气时气道分泌物的状况分为A、B两组,各60例,A组插管时已有口鼻分泌物溢出,B组插管时仅咽部有分泌物溢出。并从对两组病例的症状、体征、血糖、氧合指数、住院天数、机械通气时间、预后的资料等方面,对两组机械通气时气道分泌物的状况进行比较。结果 B组患儿的神经系统主要受损产生的症状为昏迷、抽搐、表情淡漠、呛咳、吞咽困难、悬雍垂偏位、肺部体征等发生率与A组患儿相比较,差异无统计学意义(P> 0.05);两组患儿发病年龄、入ICU时病程、血糖、EV71感染的阳性率相比较差异无统计学意义(P> 0.05);B组氧合指数、机械通气时间、平均住院日、治愈好转率等指标明显优于A组,差异有统计学意义(P <0.05)。结论危重症HFMD患儿在中枢神经受损时期,当咽部出现分泌物的时候,需要及时进行相应的机械通气,从而使患儿的病死率以及治疗成本得以明显降低。

Objective To explore the timing of mechanical ventilation of HFMD in order to reasonably grasp the timing and reduce the mortality and morbidity of HFMD in critically ill patients and to avoid over-medical treatment. Methods One hundred and twenty children who underwent mechanical ventilation were enrolled in ICU of our hospital infection department from December 2015 to December 2016. All patients were divided into A group and B group according to the status of airway secretions during mechanical ventilation, 60 eases in each group. A group： Oral and nasal secretions have spilled intubation, B group： Intubation only when the throat secretions overflow. The airway secretions were compared between the two groups in terms of symptoms, signs, blood glucose, oxygenation index, length of hospital stay, mechanical ventilation time and prognosis. Results The main symptoms of the nervous system in children of group B were unconsciousness, convulsions, apathy, choking, difficulty swallowing, deviation of uvula and signs of lung, the difference was not statistically significant compared with those in group A（P 〉 0.05）. There was no significant difference between the two groups in onset age, course of disease, blood glucose and EV71 infection in the two groups（P 〉 0.05）. The oxygenation index, mechanical ventilation time, hospitalization days, cure rate and other indicators were significantly better than those of A group, the data were statistically significant differences （ P 〈 0.05）. Conclusion During the period of central nervous system injury in critically ill children with hand-foot-mouth disease, mechanical ventilation should be carried out in time when secretions from pharynx appear, so that the mortality and cost of treatment can be significantly reduced.