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儿童重度哮喘急性发作：气管插管与机械通气

Author
Joy D Howell, MD
Section Editors
Gregory Redding, MD
Adrienne G Randolph, MD, MSc
Deputy Editor
Elizabeth TePas, MD, MS
Translators
钱素云, 主任医师，教授

引言

在美国，哮喘是儿童最常见的住院原因，并且近500,000例入住儿童危重监护病房(pediatric intensive care unit, PICU)的原因为哮喘[1]。自1996年起，儿童和成人的哮喘死亡率保持相当恒定，但在此之前，哮喘的死亡率曾持续增长[1,2]。

本文将讨论重度哮喘急性发作(即，哮喘持续状态)儿童的气管插管和机械通气。重症监护病房(intensive care unit, ICU)的一般治疗(主要是药物治疗)和非ICU住院患者的治疗将单独作更详细的讨论。成人重度哮喘的机械通气也见其他专题。 (参见“儿童重度哮喘急性发作：重症监护病房治疗”和“儿童哮喘急性发作：住院患者处理”和“有创机械通气在成人哮喘急性发作中的应用”)

急性哮喘发作的药物治疗和儿童慢性哮喘的管理也将单独讨论。 (参见“儿童哮喘急性发作的急诊科治疗”和“12岁以下儿童的哮喘：初始评估和诊断”和“12岁以下儿童的哮喘：使用控制药物治疗持续哮喘”和“12岁以下儿童哮喘：急性症状的急救治疗”)

一般原则

急诊科初步治疗后病情未改善的急性重度哮喘患儿应被收入PICU。这些患儿ICU水平的管理包括：给予糖皮质激素、积极应用支气管扩张剂治疗和密切监测[3]。无创正压通气(noninvasive positive pressure ventilation, NPPV)可通过在药物治疗发挥出最大疗效前减少呼吸功，从而避免许多向呼吸肌疲劳进展的患者对气管插管的需要。 (参见“儿童重度哮喘急性发作：重症监护病房治疗”，关于‘药物治疗’一节和“儿童重度哮喘急性发作：重症监护病房治疗”，关于‘无创正压通气’一节)

机械通气仅用于尽管采取了最大程度的内科治疗，但仍持续向呼吸衰竭进展的患者。在哮喘发作期间实施机械通气会导致相关并发症，但因收入ICU后发生并发症而死亡的病例少见[4-7]。在不同的医疗中心，哮喘患儿的机械通气率不同，发表研究所报道的通气率低至1%，高至10%-20%[4,5,7]。 (参见下文‘气管插管与机械通气’和‘结局’和“儿童重度哮喘急性发作：重症监护病房治疗”，关于‘预后’一节)

                                

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Literature review current through: 2017-07 . | This topic last updated: 2016-07-29.
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