摘要目的 探讨上气道梗阻(UAO)并发负压性肺水肿(NPPE)的发病情况、临床特点和治疗.方法 回顾性分析安徽省儿童医院PICU于2007年3月至2013年5月收治的3例UAO并发NPPE患儿的临床资料.结果 (1)3例患儿男2例,女1例.年龄分别为6个月、1岁4个月、2岁6个月.气道异物1例,喉炎1例,咽后壁脓肿1例.NPPE出现时间见于梗阻解除后5、20、40 min.(2)表现为梗阻解除后忽然发生呼吸困难、呼吸增快、渐进性血氧饱和度下降、心率增快、肺部湿啰音、2例气道内粉红色泡沫痰、1例气道内未见粉红色泡沫痰、喘息.(3) NPPE患儿胸部X线片显示弥漫性间质及肺泡浸润,肺水肿存在.(4)治疗:3例均采用机械通气,使用高PEEP(最高7 cmH2O,1 cmH2O =0.098 kPa),使用利尿剂,保证循环稳定情况下限制液体量至80 ～ 90 ml/(kg·d).肺部啰音分别于发病10、6、12 h消失,例1因继发感染50 h后撤除呼吸机,例2、例3在24h内撤除呼吸机.治愈出院,随诊未见异常.结论 NEEP常见于UAO解除后,病情进展迅速,表现为梗阻解除后迅速发生呼吸窘迫症状,胸X线片示肺水肿表现,及早呼吸支持及利尿剂使用,预后良好.

abstractsObjective To investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with upper airway obstruction (UAO) in children.Method Data of 3 cases with NPPE and UAO in pediatric intensive care unit (PICU) from Mar,2007 to May,2013 were analyzed.Result (1) Two cases were male and 1 was female with age respectively 6,16 and 30 months.One had airway foreign body,1 laryngitis,and 1 retropharyngeal abscess.The onset of NPPE varied from 5 to 40 minutes following relief of obstruction.(2) NPPE presented with acute respiratory distress with signs of tachypnea,tachycardia,2 of the 3 with pink frothy pulmonary secretions,progressively decreased oxygen saturation,rales on chest auscultation and wheezing.(3) NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates,images confirmed pulmonary edema.(4) All these patients received these therapeutic measures including mechanical ventilation,retaining high PEEP,diuretics,limiting the fluid input volume to 80-90 ml/(kg · d) on the basis of circulation stability.The rales on chest auscultation disappeared after 10,6,12 hours.The ventilators of 2 patients were removed within 24 hours,in another case it was removed 50 hours later because of secondary infection.All patients were cured and discharged without complication.Couclusion NPPE progresses very fast,characterized by rapid onset of symptoms of respiratory distress after UAO,with pulmonary edema on chest radiograph.The symptoms resolve rapidly if early support of breath and diuretics are applied properly.