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目的分析不同病因所致儿童急性呼吸窘迫综合征(ARDS)的临床特点与治疗方法。方法对厦门大学附属第一医院儿科重症监护室2010年1月至2012年6月收治的21例ARDS患儿临床资料进行总结,并作回顾性分析。结果 21例中男13例,女8例。发病平均年龄1.5岁。病因包括重症肺炎12例(57%),严重脓毒症4例,吸入性肺炎4例,肺含铁血黄素沉着症1例。痊愈13例(65%)、死亡8例,其中4例吸入性肺炎所致ARDS经多次支气管肺泡灌洗、呼吸机支持等治疗,全部治愈;1例肺含铁血黄素沉着症痊愈;重症肺炎痊愈6例。4例患儿给予了血液净化(CBP)治疗,2例脓毒症患儿好转,另2例重症肺炎患儿病情无改善。8例死亡患儿最后均并发多脏器功能不全(MODS)。结论不同病因所致ARDS治疗的侧重点不同,吸入性肺炎者应尽早行支气管肺泡灌洗,重症肺炎予针对性抗感染,脓毒症者应尽早行血液净化治疗。早期诊断、合理治疗是降低病死率的关键。
Objective To analyze the clinical features and treatment of acute respiratory distress syndrome (ARDS) in children with different etiologies. Methods The clinical data of 21 ARDS children admitted to the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xiamen University from January 2010 to June 2012 were summarized and analyzed retrospectively. Results in 21 cases, 13 males and 8 females. The average age of onset 1.5 years old. Causes include severe pneumonia in 12 cases (57%), severe sepsis in 4 cases, 4 cases of aspiration pneumonia, pulmonary hemosiderosis in 1 case. Thirteen cases (65%) were cured and 8 died. Among them, four cases of ARDS caused by aspiration pneumonia were cured by multiple bronchoalveolar lavage and ventilator support, and all were cured. One case of pulmonary hemosiderosis recovered, Pneumonia cured in 6 cases. Four children were treated with blood purification (CBP), two patients with sepsis improved, and the other two patients with severe pneumonia did not have any improvement. All 8 patients died of multiple organ dysfunction (MODS). Conclusions ARDS treatment due to different etiologies has different emphases. Patients with aspiration pneumonia should be treated with bronchoalveolar lavage as soon as possible. Severe pneumonia should be given anti-infection and sepsis should be treated with blood purification as soon as possible. Early diagnosis, reasonable treatment is the key to reducing mortality.