中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
7期
531-534
,共4页
孙静敏%金丹群%许愿愿%李敏
孫靜敏%金丹群%許願願%李敏
손정민%금단군%허원원%리민
上气道阻塞%气道异物%喉痉挛%负压性肺水肿
上氣道阻塞%氣道異物%喉痙攣%負壓性肺水腫
상기도조새%기도이물%후경련%부압성폐수종
Upper airway obstruction%Airway foreign body%Laryngospasm%Negative pressure pulmonary edema
目的 探讨上气道梗阻(UAO)并发负压性肺水肿(NPPE)的发病情况、临床特点和治疗.方法 回顾性分析安徽省儿童医院PICU于2007年3月至2013年5月收治的3例UAO并发NPPE患儿的临床资料.结果 (1)3例患儿男2例,女1例.年龄分别为6个月、1岁4个月、2岁6个月.气道异物1例,喉炎1例,咽后壁脓肿1例.NPPE出现时间见于梗阻解除后5、20、40 min.(2)表现为梗阻解除后忽然发生呼吸困难、呼吸增快、渐进性血氧饱和度下降、心率增快、肺部湿啰音、2例气道内粉红色泡沫痰、1例气道内未见粉红色泡沫痰、喘息.(3) NPPE患儿胸部X线片显示弥漫性间质及肺泡浸润,肺水肿存在.(4)治疗:3例均采用机械通气,使用高PEEP(最高7 cmH2O,1 cmH2O =0.098 kPa),使用利尿剂,保证循环稳定情况下限制液体量至80 ～ 90 ml/(kg·d).肺部啰音分别于发病10、6、12 h消失,例1因继发感染50 h后撤除呼吸机,例2、例3在24h内撤除呼吸机.治愈出院,随诊未见异常.结论 NEEP常见于UAO解除后,病情进展迅速,表现为梗阻解除后迅速发生呼吸窘迫症状,胸X线片示肺水肿表现,及早呼吸支持及利尿剂使用,预后良好.
目的 探討上氣道梗阻(UAO)併髮負壓性肺水腫(NPPE)的髮病情況、臨床特點和治療.方法 迴顧性分析安徽省兒童醫院PICU于2007年3月至2013年5月收治的3例UAO併髮NPPE患兒的臨床資料.結果 (1)3例患兒男2例,女1例.年齡分彆為6箇月、1歲4箇月、2歲6箇月.氣道異物1例,喉炎1例,嚥後壁膿腫1例.NPPE齣現時間見于梗阻解除後5、20、40 min.(2)錶現為梗阻解除後忽然髮生呼吸睏難、呼吸增快、漸進性血氧飽和度下降、心率增快、肺部濕啰音、2例氣道內粉紅色泡沫痰、1例氣道內未見粉紅色泡沫痰、喘息.(3) NPPE患兒胸部X線片顯示瀰漫性間質及肺泡浸潤,肺水腫存在.(4)治療:3例均採用機械通氣,使用高PEEP(最高7 cmH2O,1 cmH2O =0.098 kPa),使用利尿劑,保證循環穩定情況下限製液體量至80 ～ 90 ml/(kg·d).肺部啰音分彆于髮病10、6、12 h消失,例1因繼髮感染50 h後撤除呼吸機,例2、例3在24h內撤除呼吸機.治愈齣院,隨診未見異常.結論 NEEP常見于UAO解除後,病情進展迅速,錶現為梗阻解除後迅速髮生呼吸窘迫癥狀,胸X線片示肺水腫錶現,及早呼吸支持及利尿劑使用,預後良好.
목적 탐토상기도경조(UAO)병발부압성폐수종(NPPE)적발병정황、림상특점화치료.방법 회고성분석안휘성인동의원PICU우2007년3월지2013년5월수치적3례UAO병발NPPE환인적림상자료.결과 (1)3례환인남2례,녀1례.년령분별위6개월、1세4개월、2세6개월.기도이물1례,후염1례,인후벽농종1례.NPPE출현시간견우경조해제후5、20、40 min.(2)표현위경조해제후홀연발생호흡곤난、호흡증쾌、점진성혈양포화도하강、심솔증쾌、폐부습라음、2례기도내분홍색포말담、1례기도내미견분홍색포말담、천식.(3) NPPE환인흉부X선편현시미만성간질급폐포침윤,폐수종존재.(4)치료:3례균채용궤계통기,사용고PEEP(최고7 cmH2O,1 cmH2O =0.098 kPa),사용이뇨제,보증순배은정정황하한제액체량지80 ～ 90 ml/(kg·d).폐부라음분별우발병10、6、12 h소실,례1인계발감염50 h후철제호흡궤,례2、례3재24h내철제호흡궤.치유출원,수진미견이상.결론 NEEP상견우UAO해제후,병정진전신속,표현위경조해제후신속발생호흡군박증상,흉X선편시폐수종표현,급조호흡지지급이뇨제사용,예후량호.
Objective To investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with upper airway obstruction (UAO) in children.Method Data of 3 cases with NPPE and UAO in pediatric intensive care unit (PICU) from Mar,2007 to May,2013 were analyzed.Result (1) Two cases were male and 1 was female with age respectively 6,16 and 30 months.One had airway foreign body,1 laryngitis,and 1 retropharyngeal abscess.The onset of NPPE varied from 5 to 40 minutes following relief of obstruction.(2) NPPE presented with acute respiratory distress with signs of tachypnea,tachycardia,2 of the 3 with pink frothy pulmonary secretions,progressively decreased oxygen saturation,rales on chest auscultation and wheezing.(3) NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates,images confirmed pulmonary edema.(4) All these patients received these therapeutic measures including mechanical ventilation,retaining high PEEP,diuretics,limiting the fluid input volume to 80-90 ml/(kg · d) on the basis of circulation stability.The rales on chest auscultation disappeared after 10,6,12 hours.The ventilators of 2 patients were removed within 24 hours,in another case it was removed 50 hours later because of secondary infection.All patients were cured and discharged without complication.Couclusion NPPE progresses very fast,characterized by rapid onset of symptoms of respiratory distress after UAO,with pulmonary edema on chest radiograph.The symptoms resolve rapidly if early support of breath and diuretics are applied properly.
