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目的:总结机械通气对手足口病重症的治疗作用,为临床上该疾病的诊断和治疗提供依据。方法:回顾性分析20例重症手足口病患儿应用呼吸机采用同步间歇指令通气模式进行支持通气,设置参数参考卫生部《手足口病诊疗指南(2010年版)》建议参数,机械通气(通气时间1~4天,平均2.94±1.01d)的临床资料、主要病情、实验室指标、救治方案。结果:20例重症患儿均为EV71感染,早期的临床症状有持续高热、呕吐、皮疹、头痛及精神萎靡。晚期呼吸急促,节律不规则,心率增快或减慢,白细胞、血乳酸、血糖升高。16例成功脱机拔管,死亡2例、自动放弃治疗2例。结论:重症手足口病变化快、特别是并发神经源肺水肿死亡率高。发现肺水肿前兆者尽早给予机械通气,是救治成功的关键。
OBJECTIVE: To summarize the therapeutic effect of mechanical ventilation on severe hand-foot-mouth disease and provide the basis for the diagnosis and treatment of the disease clinically. Methods: Twenty children with severe HFMD were retrospectively analyzed. Ventilator ventilatory ventilation was performed with synchronized intermittent mandatory ventilation. The parameters were set according to the recommended parameters of the Department of Hand, Foot and Mouth Disease Diagnosis and Treatment Guidelines (2010 Edition) 1 to 4 days, an average of 2.94 ± 1.01d) clinical data, the main condition, laboratory indicators, treatment options. Results: All the 20 critically ill children were infected with EV71. The early clinical symptoms were persistent fever, vomiting, rash, headache and apathetic. Late shortness of breath, irregular rhythm, heart rate faster or slower, white blood cells, blood lactate, elevated blood sugar. 16 cases successfully extubated, died in 2 cases, 2 cases were automatically given up for treatment. Conclusion: Severe hand-foot-mouth disease changes rapidly, especially the high incidence of neurogenic pulmonary edema. Discovery of pulmonary edema as soon as possible to give mechanical ventilation, the key to the success of treatment.