Hendriks Tom, de Hoog Matthijs, Lequin Maarten H, Devos Annick S, Merkus Peter J F M
Catharina Hospital, Eindhoven, The Netherlands.
Crit Care. 2005 Aug;9(4):R351-6. doi: 10.1186/cc3544. Epub 2005 May 20.
No evidence based treatment is available for atelectasis. We aimed to evaluate the clinical and radiologic changes in pediatric patients who received DNase for persistent atelectasis that could not be attributed to cardiovascular causes, and who were unresponsive to treatment with inhaled bronchodilators and physiotherapy.
All non-cystic fibrosis pediatric patients who received nebulised or endotracheally instilled DNase for atelectasis between 1998 and 2002, with and without mechanical ventilation, were analysed in a retrospective descriptive study. The endpoints were the blood pCO2, the heart rate, the respiratory rate, the FiO2 and the chest X-ray scores before and after treatment.
In 25 of 30 patients (median [range] age, 1.6 [0.1-11] years) who met inclusion criteria, paired data of at least three endpoints were available. All clinical parameters improved significantly within 2 hours (P < 0.01), except for the heart rate (P = 0.06). Chest X-ray scores improved significantly within 24 hours after DNase treatment (P < 0.001). Individual improvement was observed in 17 patients and no clinical change was observed in five patients. Temporary deterioration (n = 3) was associated with increased airway obstruction and desaturations. No other complications were observed.
After treatment with DNase for atelectasis of presumably infectious origin in non-cystic fibrosis pediatric patients, rapid clinical improvement was observed within 2 hours and radiologic improvement was documented within 24 hours in the large majority of children, and increased airway obstruction and ventilation-perfusion mismatch occurred in three children, possibly due to rapid mobilisation of mucus. DNase may be an effective treatment for infectious atelectasis in non-cystic fibrosis pediatric patients.
目前尚无针对肺不张的循证治疗方法。我们旨在评估接受脱氧核糖核酸酶（DNase）治疗的儿科患者的临床和放射学变化，这些患者患有持续性肺不张且非心血管原因所致，对吸入支气管扩张剂和物理治疗无反应。
在一项回顾性描述性研究中，分析了1998年至2002年间所有因肺不张接受雾化或气管内滴注DNase治疗的非囊性纤维化儿科患者，无论是否接受机械通气。观察终点为治疗前后的血二氧化碳分压（pCO2）、心率、呼吸频率、吸入氧分数（FiO2）和胸部X线评分。
30例符合纳入标准的患者中，25例（年龄中位数[范围]为1.6[0.1 - 11]岁）有至少三个观察终点的配对数据。除心率外（P = 0.06），所有临床参数在2小时内均显著改善（P < 0.01）。DNase治疗后24小时内胸部X线评分显著改善（P < 0.001）。17例患者有个体改善，5例患者无临床变化。3例出现暂时恶化，与气道阻塞增加和血氧饱和度下降有关。未观察到其他并发症。
在非囊性纤维化儿科患者中，使用DNase治疗可能由感染引起的肺不张后，绝大多数儿童在2小时内出现快速临床改善，24小时内有放射学改善记录，3例儿童出现气道阻塞增加和通气 -血流不匹配，可能是由于黏液快速移动所致。DNase可能是治疗非囊性纤维化儿科患者感染性肺不张的有效方法。
