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目的探讨自制CPAP对重症手足口病进行早期气道干预与低流量吸氧治疗重症手足口病的疗法相比在疗效和不良反应上有何差异。方法随机选择我科诊断为重症手足口病的住院患儿共200例,重症手足口病的诊断参照国家卫生部《手足口病诊疗指南(2010年版)》中的临床诊断标准。随机分为治疗组和对照组,治疗组给予自制CPAP通气,对照组给予低流量吸氧。两组患儿的药物治疗及监测方法相同。治疗组在对照组的基础上及时给予早期CPAP治疗。比较两组体温、呼吸、心率、血压恢复正常时间及转化为危重型的发生概率,以及不良反应的发生率。结果自制CPAP对重症手足口病进行早期气道干预,可增加跨肺压力,使自主呼吸变得有规律,节省肺泡表面活性物质,压低膈肌等作用,通过扩张萎陷的肺泡,增加功能残气量,改善氧合作用,降低气道阻力,改善通气功能,使病情稳定,并减少机械通气的需要,使用越早,疗效越显著。是经济不发达地区及基层医院儿科的一种简便易行、无创安全、经济且疗效显著的呼吸支持设备。
Objective To investigate the difference between curative effect and adverse reaction of home-made CPAP for early hand airway disease in patients with severe hand-foot-mouth disease and low-flow oxygen therapy for severe hand-foot-mouth disease. Methods A total of 200 hospitalized children diagnosed as severe hand-foot-mouth disease were randomly selected. The diagnosis of severe hand-foot-mouth disease was based on the clinical diagnostic criteria in Hand-Foot-Mouth Disease Diagnosis and Treatment Guidelines (2010 Edition) issued by the Ministry of Health. Randomly divided into treatment group and control group, the treatment group given home-made CPAP ventilation, the control group given low-flow oxygen. Two groups of children with the same drug treatment and monitoring methods. The treatment group was given early CPAP treatment on the basis of the control group. The body temperature, respiration, heart rate, blood pressure recovery time and the probability of conversion to critical type and the incidence of adverse reactions were compared between the two groups. Results Self-made CPAP for early hand airway disease in severe HFMD can increase trans-pulmonary pressure, make spontaneous breathing become regular, save the alveolar surfactant, depress the diaphragm and so on. Expand the collapsed alveoli and increase the functional residual capacity , Improve oxygenation, reduce airway resistance, improve ventilation, make the disease stable, and reduce the need of mechanical ventilation. The earlier the use, the more obvious the curative effect. It is an easy, non-invasive, safe, economical and effective respiratory support equipment for pediatric patients in economically underdeveloped areas and primary hospitals.