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儿童重度哮喘急性发作：重症监护病房治疗

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

引言

哮喘是美国儿童住院最常见的原因，并且近500,000例入住儿童危重监护病房(pediatric intensive care unit, PICU)的病例是由于哮喘 [1]。因哮喘入住重症监护病房的病例与哮喘一般住院病例成比例地升高[2]。儿童的死亡率低于成人，但男性和非洲裔美国人的死亡风险高于女孩和白种美国人。

重度哮喘急性发作(即，哮喘持续状态)患儿的重症监护病房(intensive care unit, ICU)处理将在此讨论，而气管插管和机械通气将单独讨论。对非ICU住院患者的处理也将单独详细讨论。成人重度哮喘的机械通气也将单独总结。 (参见“儿童重度哮喘急性发作：气管插管与机械通气”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”)

哮喘急性发作的药物治疗及儿童慢性哮喘的治疗也将单独讨论。 (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”)

概述

哮喘的病理特征为气道炎症、黏液产生过多、黏液栓和气道支气管痉挛，以上所有这些均可能导致重度气流阻塞。气流阻塞能导致不同程度的呼吸功能不全，并且可以进展为呼吸衰竭。将一名急性哮喘发作患儿收住院时，哮喘发作的严重程度及是否存在需要进行ICU处理的相关危险因素都应纳入考虑。

严重程度评估 — 根据存在的体征和症状以及对治疗的反应，可略微宽松地定义急性重度哮喘(表 1)。有多个评分系统有助于评估儿童哮喘的严重程度。例如，肺指数评分(表 2)[3]和肺评分，肺评分与肺指数评分相似，但它仅涉及对呼吸频率、哮鸣音和使用辅助呼吸肌的评分[4]。另一种是PICU儿科哮喘评分，该评分中计入了相对于年龄的呼吸频率、氧需、是否存在三凹征、说话时是否呼吸困难以及是否存在喘鸣[5]。对哮喘急性发作严重程度的评估将单独详细讨论。 (参见“儿童哮喘急性发作：在家中或诊室的处理和疾病严重程度的评估”，关于‘评估哮喘发作的严重程度’一节)

                         

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Literature review current through: 2017-07 . | This topic last updated: 2016-10-28.
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