机械通气治疗儿童危重症甲型H1N1流感肺炎临床观察

目的:探讨机械通气在治疗儿童危重症甲型H1N1流感肺炎的作用。方法:回顾性分析实施机械通气的11例危重症儿童甲型H1N1流感肺炎的临床资料,根据机械通气的选择时机分A组7例为早期机械通气组,B组4例为常规机械通气组。对该病机械通气指征、呼吸机参数、机械通气时间及治疗效果进行分析。结果:A组在出现气促、胸片两肺出现模糊影、血气示过度通气即予正压通气,呼吸机参数吸气峰压(PIP)达22 cm H2O、呼气末正压(PEEP)达7 cm H2O、氧浓度(FiO2)40%～50%即可改善低氧血症,总上机时间4～5天,全部治愈。B组出现明显低氧血症、肺部大量湿罗音、胸片示两肺白肺、血气示Ⅰ型甚至Ⅱ型呼吸衰竭时上呼吸机,呼吸机参数PIP高达25 cm H2O、PEEP高达10 cm H2O、FiO280%～100%仍不能改善低氧血症,机械通气持续24～48 h后经皮氧饱和度方升至90%以上,总上机时间7～10天,1例死亡、3例安全撤机。结论:早期机械通气是治疗儿童甲型H1N1流感肺炎合并急性呼吸窘迫综合征的有效途径;以最小的PEEP达到适宜的氧合指标是提高机械通气成功率、防止肺损伤的关键。

Clinical observation on mechanical ventilation in treatment of pediatric severe pneumonia caused by H1N1 influenza

Objective:To explore the function of mechanical ventilation in treatment of pediatric severe pneumonia caused by H1N1 influenza.Methods:The clinical data of 11 children with severe pneumonia caused by H1N1 influenza who underwent mechanical ventilation in the hospital were analyzed retrospectively,then they were divided into group A(7 children,early mechanical ventilation group) and group B(4 children,routine mechanical ventilation group) according to the opportunity of mechanical ventilation.The indications of mechanical ventilation,parameters of ventilator,the time of mechanical ventilation,and curative effect were analyzed.Results:The children in group A were treated with positive pressure ventilation when anhelation,fuzzy shadow of both lungs displayed by chest film,hyperventilation displayed by blood gas analysis occurred,the parameters of ventilator: peak inspiratory pressure(PIP) 22 cm H2O,positive end expiratory pressure(PEEP) 7 cm H2O,FiO2 40%-50%,then hyoxemia was improved,the total application time of mechanical ventilation was 4-5 days,all the children in group A were cured.The children in group B were treated with mechanical ventilation when obvious hypoxemia,large number of wet lung rales," white lung" in both lungs displayed by chest film,type Ⅰeven type Ⅱ respiratory failure displayed by blood gas analysis occurred,the parameters of ventilator: PIP 25 cm H2O,PEEP 10 cm H2O,FiO2 80%-100%,hypoxemia couldn’t be improved,after 24-48 hours,transcutaneous oxygen saturation increased to more than 90%,the total application time of mechanical ventilation was 7-10 days,one child died,and the other three children were removed from ventilator safely.Conclusion:Early mechanical ventilation is an effective method to treat pediatric severe pneumonia caused by H1N1 influenza combined with acute respiratory distress syndrome(ARDS);the key point of improving the success rate of mechanical ventilation and preventing pulmonary damage is achieving optimal oxygenation index with the minimal PEEP.