ACREM  >> Vol. 4 No. 1 (February 2016)

    机械通气联合CRRT及亚低温复合技术治疗重症手足口病患儿神经源性肺水肿的临床研究
    The Clinical Study of the Combined Treatment by Mechanical Ventilation Jointing Systemic Hypothermia and CRRT for Neurogenic Pulmonary Edema with Severe Hand, Foot and Mouth Disease in Children

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作者:  

罗菲菲,许愿愿,李小双,孙静敏,江家云,徐卫华,徐达良,刘利,张美英,解启莲:安徽省儿童医院急救中心,安徽 合肥

关键词:
机械通气CRRT亚低温手足口病神经元性肺水肿儿童Mechanical Ventilation CRRT Mild Hypothermia Hand-Foot-Mouth Disease Neurogenic Pulmonary Edema Children

摘要:

目的:探讨全身亚低温及CRRT联合机械通气复合式治疗重症手足口病患儿神经源性肺水肿的临床疗效。方法:将26例患儿随机分为复合式治疗组(亚低温 + CRRT + 机械通气组,13例)和对照组(机械通气组,13例)。分别记录患儿抢救成功率及上机时间,以及治疗前及治疗后两组患儿肝肾功能的变化。结果:复合式治疗组的抢救成功率明显高于对照组,上机时间明显短于对照组,并且治疗72小时后的复合式治疗组的肝肾功能明显优于对照组组,差异均具有统计学意义。结论:全身亚低温及CRRT联合机械通气的复合式治疗可以明显提高重症手足口病患儿抢救成功率,改善其预后,值得临床运用推广。

Objective: To investigate the clinical curative effect of combined treatment by mechanical ventila-tion jointing systemic hypothermia and CRRT for neurogenic pulmonary edema with severe hand, foot and mouth disease in children. Methods: 26 cases were randomly divided into combined treatment group (hypothermia + CRRT + mechanical ventilation group, 13 cases) and control group (mechanical ventilation group, 13 cases). The rescue success rate and time of mechanical ventila-tion respectively, and the change of function of liver and kidney before and after treatment in two groups were recorded. Results: The rescue success rate of compound treatment group was ob-viously higher than that of control group; the time of mechanical ventilation was shorter than the control group; and the function of liver and kidney after 72 hours was better than control way. The differences were all statistically significant. Conclusion: The combined treatment with mechanical ventilation jointing systemic hypothermia and CRRT can obviously increase rescue success rate for children with neurogenic pulmonary edema in severe hand, foot and mouth disease, and improve the prognosis. It is worthy of clinical application. 

文章引用:
罗菲菲, 许愿愿, 李小双, 孙静敏, 江家云, 徐卫华, 徐达良, 刘利, 张美英, 解启莲. 机械通气联合CRRT及亚低温复合技术治疗重症手足口病患儿神经源性肺水肿的临床研究[J]. 亚洲急诊医学病例研究, 2016, 4(1): 1-7. http://dx.doi.org/10.12677/ACREM.2016.41001

参考文献

[1] 中华人民共和国卫生部. 手足口病诊疗指南(2013年版)[S]. 北京: 中华人民共和国卫生部, 2010: 4.
[2] 钱素云. 手足口病在中国大陆的流行现状及诊治进展[J]. 中国小儿急救杂志, 2011, 18(1): 1.
[3] Ronco, C., Levin, A., Warnock, D.G., et al. (2007) Improving Outcomes from Acute Kidney Injury (AKI): Report on an Initiative. Journal of Artificial Organs, 30, 373-376.
[4] 卫生部. 肠道病毒71型(EV71)感染重症病例临床救治专家共识[J]. 2011, 49(9): 675-678.
[5] 黄光举, 张慧玉, 田玲, 等. 机械通气联合丙种球蛋白治疗小儿神经源性肺水肿的临床疗效观察[J]. 山西医药杂志, 2015, 44(6): 673-674.
[6] 邵肖梅, 周文浩, 程国强, 等. 亚低温治疗新生儿缺血缺氧性脑病方案[J]. 中国循证儿科杂志, 2011, 69(5): 337- 339.
[7] 韩咏. CRRT成功治疗5例小儿危重症手足口病(心肺衰竭期)体会[J]. 齐齐哈尔医学院学报, 2015, 36(1): 36-37.
[8] HACA (2002) Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. New England Journal of Medicine, 346, 549-556.
http://dx.doi.org/10.1056/NEJMoa012689
[9] Perlman, J.M., Wyllie, J., Kattwinkel, J., et al. (2010) Part 11: Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation, 122, S516-S538.
http://dx.doi.org/10.1161/circulationaha.110.971127
[10] Schwarzl, M., Seiler, S., Wallner, M., et al. (2013) Mild Hypothermia Attenuates Circulatory and Pulmonary Dysfunction during Experimental Endotoxemia. Critical Care Medicine, 41, 401–410.
http://dx.doi.org/10.1097/CCM.0b013e31829791da
[11] Rim, K.P., Kim, K., Jo, Y.H., Lee, J.H., Rhee, J.E., Kang, K.W., et al. (2012) Effect of Therapeutic Hypothermia According to Severity of Sepsis in a Septic Rat Model. Cytokine, 60, 755-761.
http://dx.doi.org/10.1016/j.cyto.2012.08.013
[12] Léon, K., Moisan, C., Amérand, A., Poupon, G. and L’Her, E. (2013) Effect of Induced Mild Hypothermia on Two Pro-Inflammatory Cytokines and Oxidative Parameters during Experimental Acute Sepsis. Redox Report, 18, 120-126.
http://dx.doi.org/10.1179/1351000213Y.0000000049
[13] Chang, Y.-T., Wann, S.-R., Tsai, J.-S., Kao, C.-H., Lee, P.-T., Huang, N.-C., et al. (2013) The Role of Autonomic Nervous System Function in Hypothermia-Mediated Sepsis Protection. The American Journal of Emergency Medicine, 31, 375-380.
http://dx.doi.org/10.1016/j.ajem.2012.08.028
[14] Hypothermia after Cardiac Arrest Study Group (2002) Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. The New England Journal of Medicine, 346, 549-556.
http://dx.doi.org/10.1056/NEJMoa012689
[15] Kim, K. (2010) Induced Hypothermia Attenuates the Acute Lung Injury in Hemorrhagic Shock. The Journal of Trauma—Injury, Infection, and Critical Care, 68, 373-381.
http://dx.doi.org/10.1097/TA.0b013e3181a73eea
[16] Gallardo, F., Gallardo Garcia, M.B., Cabra, M.J., Curiel, E., Arias, M.D., Muñoz, A. and Aragón, C. (2010) Nutrition and Anaemias in Critical Illness. Nutrición Hospitalaria, 25, 99-106.
[17] 罗菲菲. 全身亚低温技术对多器官功能障碍综合征患儿器官功能的影响[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2014.
[18] 李双杰. 肠道病毒71型感染性疾病[J]. 实用儿科临床杂志, 2008, 23(22): 1780-1782.
[19] Maron, M.B., Holcomb, P.H., Dawson, C.A., Rickaby, D.A., Clough, A.V. and Linehan, J.H. (1994) Edema Development and Recovery in Neurogenic Pulmonary Edema. Journal of Applied Physiology, 77, 1155-1163.
[20] 杨志焕, 杨志林, 王正国, 冷华光, 刘宝松, 李晓炎. 颅脑撞击伤后神经源性肺水肿发生机理的实验研究[J]. 中国创伤杂志, 1995, 1(2): 82-84.
[21] 董广宇, 郭伟, 陈建良. 神经源性肺水肿研究现状[J]. 国外医学神经病学与神经外科学分册, 2004, 31(2): 170- 172.
[22] Fu, D., Li, C.R., He, Y.X., Zu, Y., Cao, D.Z., Wang, G.B., Deng, J.K. and Wang, H.P. (2009) Changes of Immune Function in Patients with Enterovirus 71 Infection. Chi-nese Journal of Pediatrics, 47, 829-834.
[23] Wang, S.-M., Lei, H.-Y., Su, L.-Y., Wu, J.-M., Yu, C.-K., Wang, J.-R. and Liu, C.-C. (2007) Cerebrospinal Fluid Cytokines in Enterovirus 71 Brain Stem Encephalitis and Echovirus Menin-gitis Infections of Varying Severity. Clinical Microbiology and Infection, 13, 677-682.
http://dx.doi.org/10.1111/j.1469-0691.2007.01729.x
[24] 蒋玉红, 宋金莲, 王亚秋, 牟文凤, 陈艳萍. 免疫反应及相关细胞因子在EV71相关手足口病合并肺水肿中的作用[J]. 2012, 12(3): 497-500.
[25] 郭亚男. 重症手足口病患儿血中儿茶酚胺含量测定及相关因素分析[D]: [硕士学位论文]. 大理: 大理学院, 2013.
[26] Sedy, J., Zicha, J., Kunes, J., Jendelová, P. and Syková, E. (2008) Mechanisms of Neurogenic Pulmonary Edema Development. Physiological Research, 57, 499-506.
[27] Baumann, A., Audibert, G., Mcdonnel, J. and Mertes, P.M. (2007) Neuro-genic Pulmonary Edema. Acta Anaesthesiologica Scandinavica, 51, 447-455.
http://dx.doi.org/10.1111/j.1399-6576.2007.01276.x
[28] Fu, Y.C., Chi, C.S., Chiu, Y.T., Hsu, S.L., Hwang, B., Jan, S.L., et al. (2004) Cardiac Complications of Enterovirus Rhombencephalitis. Archives of Disease in Childhood, 89, 368-373.
http://dx.doi.org/10.1136/adc.2003.029645
[29] Kao, S.J., Yang, F.L., Hsu, Y.H. and Chen, H.I. (2004) Mechanism of Falminant Pulmonary Edenla Caused by Enterovirus 71. Clinical Infectious Diseases, 38, 1784-1788.
http://dx.doi.org/10.1086/421021
[30] Kaija, H., Pakanen, L., Uvsitalo, J., Nikkiä, S., Kortelainen, M.-L. and Porvari, K.S. (2014) Change in Cardiac Thrombomodulin and Heat Shock Transcription Factor 1 Expression and Pe-ripheral Thrombomodulin and Catecholamines during Hypothermia in Rats. Stress, 17, 504-511.
http://dx.doi.org/10.3109/10253890.2014.953477
[31] Hakim, T.S., Pedoto, A., Nandi, J., Bosco, G., Rubini, A., Mangar, D., Paoli, A. and Camporesi, E.M. (2014) Hypothermia Attenuates NO Production in Anesthetized Rats with Endotoxemia. Naunyn-Schmiedeberg’s Archives of Pharmacology, 387, 659-665.
http://dx.doi.org/10.1007/s00210-014-0977-1
[32] 彭文革, 赵丽娟, 陈静, 郝燕杰, 张佛增, 周利卫. 手足口病患儿脑脊液及肝功能结果分析[J]. 河北医学, 2015, 37(1): 57-59.