儿童甲型H1N1流感急性呼吸窘迫综合征人工通气策略的探讨

目的探讨重症甲型H1N1流感患儿应用有创通气治疗过程中的策略。方法对10例重症甲型H1N1流感患儿常规治疗失败后,经鼻或口气管插管进行有创人工通气,并早期应用神经氨酸酶抑制剂(奥司他韦),对通气过程中的并发症和患儿的转归进行分析。结果 10例患儿均高热(体温>38.5℃),9例(90.00%)患者的WBC总数在正常范围,仅1例高于正常。应用模式为压力调节+呼气末正压,即PCV+PEEP或PRVC+PEEP,压力为(1.72±0.53)kPa,PEEP为(0.85±0.16)kPa,通气时间为(11.5±7.4)天。10例患儿确诊后均及时接受了奥司他韦治疗,无不良反应。10例患儿均成功撤离人工通气并拔除人工气道。结论有创人工通气能有效提高重症甲型H1N1流感患儿的抢救成功率。

The modes of mechanical ventilation for children with A /H1N1 influenza associated with ARDS

Objective To study the modes of invasive mechanical ventilation for children with severe A/H1N1 influenza. Methods Ten children with severe A /H1N1 influenza were enrolled in this study.After failure of conventional treatment,the endotracheal intubation and invasive mechanical ventilation via nose or transmouth had been performed for all selected cases,early in combination with Oseltamivir(a neuraminidase inhibitor).The complications during the invasive ventilation and prognosis were evaluated. Results All children suffered with high fever(body temperature >38.5℃),9 of them(90.00%) with normal white blood cell(WBC) counts and only one case with an increased WBC count.The intermittent positive pressure ventilation as the modes of pressure control ventilation+positive end-expiratory pressure,PCV+PEEP or PRVC+PEEP were applied to all children.The initiative pressure of PCV was(1.72±0.53) kPa and the pressure of PEEP was(0.85±0.16) kPa.The average time of ventilation was(11.5±7.4) days.All children did not suffer with adverse reactions after treatment with Oseltamivir as soon as diagnosed with severe A/H1N1 influenza.All children were successfully weaned from mechanical ventilation with a subsequent extubation.Conclusion The application of invasive mechanical ventilation to children with severe influenza A /H1N1 influenza increased the successful rate of rescue.