CAJ | 학술논문

目的分析入住儿童重症监护室(PICU)的麻疹患儿严重并发症的特点.方法回顾性分析安徽省儿童医院PICU 2012年5月至2013年5月收住的17例出现严重并发症的麻疹患儿,分析17例患儿的临床资料、影像学改变和转归情况.17例患儿中男9例、女8例,年龄2个月至10岁,均为血清学检测麻疹IgM抗体阳性患儿.结果 17例患儿在起病1周内因严重呼吸窘迫给予机械通气,其中14例并发急性呼吸窘迫综合征(ARDS),张力性气胸6例,3例并发喉气管支气管炎,喉梗阻Ⅲ度以上,共死亡7例.存活的10例患儿随访1年,1例包裹性气胸+支气管胸膜瘘,1例轻度肺纤维化,1例喉炎患儿持续存在声嘶,轻度吸气性呼吸困难.余7例完全康复.14例未接种麻疹疫苗.结论需人住PICU的麻疹患儿有较高的死亡风险和较差的转归,尤其是ARDS合并气胸;喉炎治疗时间长,撤机困难,有包裹性积液、支气管胸膜瘘的须手术治疗,且易继发细菌感染.
목적 분석입주인동중증감호실(PICU)적마진환인엄중병발증적특점.방법 회고성분석안휘성인동의원PICU 2012년5월지2013년5월수주적17례출현엄중병발증적마진환인,분석17례환인적림상자료、영상학개변화전귀정황.17례환인중남9례、녀8례,년령2개월지10세,균위혈청학검측마진IgM항체양성환인.결과 17례환인재기병1주내인엄중호흡군박급여궤계통기,기중14례병발급성호흡군박종합정(ARDS),장력성기흉6례,3례병발후기관지기관염,후경조Ⅲ도이상,공사망7례.존활적10례환인수방1년,1례포과성기흉+지기관흉막루,1례경도폐섬유화,1례후염환인지속존재성시,경도흡기성호흡곤난.여7례완전강복.14례미접충마진역묘.결론 수인주PICU적마진환인유교고적사망풍험화교차적전귀,우기시ARDS합병기흉;후염치료시간장,철궤곤난,유포과성적액、지기관흉막루적수수술치료,차역계발세균감염.
Objective To evaluate the characteristics of the serious complications of 17 cases with measles in ICU.Method Seventeen cases with measles with serious complications in ICU in Anhui Provincial Children's Hospital were recruited from May 2012 to May 2013.Clinical characteristics,image finding,and prognosis were analyzed retrospectively.IgM antibody was positive in all the 17 cases,which included 9 male cases,8 female cases,and their age was from 2 months to 10 years.Result All the 17 patients received mechanical ventilation because of severe respiratory distress within 1 week of onset,of which 14 cases were complicated with acute respiratory distress syndrome (acute ARDS),6 cases of tension pneumothorax,3 cases were complicated with bronchitis,laryngeal obstruction Ⅲ degrees,and totally 7 cases died.The survived 10 patients were followed up for 1 year,1 patient with localized pneumothorax,bronchopleural fistula,1 case of mild pulmonary fibrosis,1 case of acute laryngitis with persistent hoarseness,and mild inspiratory dyspnea were found.The remaining 7 cases fully recovered.Fourteen cases failed to inoculate measles vaccine.Conclusion A higher risk of death and poor prognosis were found in children with measles who needed to be treated in PICU,especially for ARDS with pneumothorax.Laryngitis needed long time to cure and had weaning difficulties,and the case associated with pleural effusion or bronchopleural fistula must be treated with surgery,and the patients easily develop secondary bacterial infection.