在一名机械通气的难治性哮喘持续状态儿童中，气管内注射重组人脱氧核糖核酸酶治疗后黏液栓阻塞和肺不张的缓解情况。
Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus.
作者信息
Durward A, Forte V, Shemie S D
机构信息
Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto.
出版信息
Crit Care Med. 2000 Feb;28(2):560-2. doi: 10.1097/00003246-200002000-00045.
OBJECTIVE
To report the dramatic resolution of unilateral mucus plugging and atelectasis in a mechanically ventilated child with refractory status asthmaticus after intratracheal recombinant human DNase (rhDNase) therapy.
DESIGN
Case report.
SETTING
Critical care unit.
PATIENT
A 7-yr-old boy with status asthmaticus, severe respiratory failure and barotrauma unresponsive to conventional therapy. Fiberoptic bronchoscopy confirmed widespread mucus impaction of the subsegmental bronchi of the left lung without response to bronchoscopic lavage.
INTERVENTIONS
Two 10-mg doses of intratracheal rhDNase were administered 8 hrs apart.
MAIN RESULTS
The left-sided atelectasis resolved 3 hrs after the first dose of rhDNase. Improvements in gas exchange and tidal volumes were sustained and particularly noticeable after the second dose. The patient was successfully extubated 26 hrs after receiving the rhDNase treatment without any adverse effects.
CONCLUSIONS
rhDNase should be considered as a potential therapy for refractory mucus plugging and atelectasis in intubated patients with status asthmaticus.
目的
报告1例机械通气的难治性哮喘持续状态患儿经气管内给予重组人脱氧核糖核酸酶（rhDNase）治疗后，单侧黏液阻塞和肺不张显著缓解的情况。
设计
病例报告。
单位
重症监护病房。
患者
一名7岁男孩，患有哮喘持续状态、严重呼吸衰竭和气压伤，对传统治疗无反应。纤维支气管镜检查证实左肺亚段支气管广泛黏液嵌塞，支气管镜灌洗无效。
干预措施
间隔8小时给予两剂10毫克气管内rhDNase。
主要结果
第一剂rhDNase给药3小时后，左侧肺不张缓解。气体交换和潮气量持续改善，第二剂给药后尤为明显。接受rhDNase治疗26小时后，患者成功拔管，无任何不良反应。
结论
rhDNase应被视为气管插管的哮喘持续状态患者难治性黏液阻塞和肺不张的潜在治疗方法。
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