Paediatric Intensive Care, Middelheim Ziekenhuis, Lindendreef 1, Antwerp, Belgium.
Paediatr Respir Rev. 2013 Jun;14(2):78-85. doi: 10.1016/j.prrv.2013.03.003. Epub 2013 Apr 8.
Recent literature on paediatric status asthmaticus (PSA) confirms an increasing percentage of admissions to paediatric intensive care units. PSA is a medical emergency that can be fatal and needs careful and prompt intervention. The severity of PSA is mainly determined by clinical judgement of signs and symptoms. Peak flow measurements and serial lung function measurements are not reliable in PSA. Validated clinically useful instruments are lacking. The three main factors that are involved in the pathophysiology of PSA, bronchoconstriction, mucus plugging and airway inflammation need to be addressed to optimise treatment. Initial therapies include supplementation of oxygen, repetitive administration of rapid acting β2-agonists, inhaled anticholinergics in combination with systemic glucocorticosteroids and intravenous magnesium sulphate. Additional treatment modalities may include methylxanthines, DNase, ketamine, sodium bicarbonate, heliox, epinephrine, non-invasive respiratory support, mechanical ventilation and inhalational anaesthetics.
近期有关儿童哮喘状态（PSA）的文献证实，越来越多的患儿需要入住儿科重症监护病房。PSA 是一种危及生命的医疗急症，需要仔细和及时的干预。PSA 的严重程度主要由体征和症状的临床判断来决定。在 PSA 中，峰值流量测量和连续的肺功能测量并不可靠。缺乏经过验证的临床有用的工具。涉及 PSA 病理生理学的三个主要因素，支气管收缩、黏液堵塞和气道炎症，需要加以解决以优化治疗。初始治疗包括补充氧气、反复给予快速作用的β2-激动剂、吸入抗胆碱能药物与全身糖皮质激素联合应用以及静脉注射硫酸镁。其他治疗方法可能包括黄嘌呤衍生物、DNase、氯胺酮、碳酸氢钠、氦氧混合气、肾上腺素、无创性呼吸支持、机械通气和吸入性麻醉剂。
