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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。
Objective: To investigate the role of mechanical ventilation in the treatment of children with severe type A (H1N1) pneumonia. Methods: The clinical data of 11 children with severe acute respiratory syndrome (H1N1) pneumonia who underwent mechanical ventilation were retrospectively analyzed. According to the timing of mechanical ventilation, 7 patients in group A were treated with early mechanical ventilation and 4 patients in group B with conventional mechanical ventilation. The disease indications of mechanical ventilation, ventilator parameters, mechanical ventilation time and treatment were analyzed. Results: In group A, there was a blurry shadow in the two lungs of chest radiograph. Positive airway pressure was found in hyperventilation of ventilator. Peak pressure of ventilator (PIP) was 22 cm H2O, positive end expiratory pressure (PEEP) Up to 7 cm H2O, oxygen concentration (FiO2) 40% ~ 50% can improve hypoxemia, the total time on the machine 4 to 5 days, all cured. B group showed obvious hypoxemia, pulmonary wet rales, chest lung showed two lungs, blood gas showed type Ⅰ or Ⅱ respiratory failure when the respirator, ventilator parameters PIP up to 25 cm H2O, PEEP up to 10 cm H2O, FiO280% ~ 100% still can not improve hypoxemia, mechanical ventilation for 24 ~ 48 h after the percutaneous oxygen saturation rose to more than 90%, the total time on the machine 7 to 10 days, 1 died, 3 Case safe weaning. Conclusion: Early mechanical ventilation is an effective way to treat children with influenza A (H1N1) pneumonia complicated with acute respiratory distress syndrome. To achieve appropriate oxygenation index with minimal PEEP is the key to improve the success rate of mechanical ventilation and prevent lung injury.