Chen Jiehua, Wang Shu, Ma Hongling, Wang Wenjian, Fu Dan, Huang Wenxian, Deng Jikui, Tang Huiying, He Yanxia, Zheng Yuejie
Division of Respiratory Disease, Shenzhen Children's Hospital, Shenzhen 518026, China.
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Zhonghua Er Ke Za Zhi. 2014 Feb;52(2):122-7.
To analyze the clinical characteristics of negative pressure pulmonary edema (NPPE).
A retrospective investigation of the clinical manifestation, imageology, clinical course and outcome of 4 children with NPPE seen between June 2012 and July 2013 in a children's hospital. The causation of the airway obstruction was also explored.
All the 4 cases were boys, the range of age was 40 days to 9 years. They had no history of respiratory and circulatory system disease. In 3 cases the disease had a sudden onset after the obstruction of airway, and in one the onset occurred 1.5 hours after removing the airway foreign body. All these cases presented with tachypnea, dyspnea, and cyanosis, none had fever. Three cases had coarse rales. Chest radiography was performed in 3 cases and CT scan was performed in 1 case, in all of them both lungs displayed diffuse ground-glass-like change and patchy consolidative infiltrates. Three cases were admitted to the ICU, duration of mechanical ventilation was less than 24 hours in 2 cases and 39 hours in one. Oxygen was given by mask to the remaining one in emergency department, whose symptoms were obviously improved in 10 hours. None was treated with diuretics, glucocorticoids or inotropic agents. Chest radiographs were taken within 24 hours of treatment in 2 cases and 24-48 hours in the other 2; almost all the pulmonary infiltrates were resolved. All the 4 cases were cured. The causes of airway obstruction were airway foreign bodies in two cases, laryngospasm in one and laryngomalacia in the other.
NPPE is a life-threatening emergency, which is manifested by rapid onset of respiratory distress rapidly (usually in several minutes, but might be hours later) after relief of the airway obstruction, with findings of pulmonary edema in chest radiograph. The symptoms resolve rapidly by oxygen therapy timely with or without mechanical ventilation. In children with airway obstruction, NPPE should be considered.
分析负压性肺水肿（NPPE）的临床特征。
对2012年6月至2013年7月间在某儿童医院就诊的4例NPPE患儿的临床表现、影像学表现、临床病程及转归进行回顾性调查。同时探讨气道梗阻的原因。
4例均为男性，年龄范围为40天至9岁。既往无呼吸及循环系统疾病史。3例在气道梗阻后突然发病，1例在取出气道异物后1.5小时发病。所有病例均表现为呼吸急促、呼吸困难和发绀，均无发热。3例有粗湿啰音。3例行胸部X线检查，1例行CT扫描，均显示双肺弥漫性磨玻璃样改变及斑片状实变影。3例入住重症监护病房（ICU），2例机械通气时间小于24小时，1例为39小时。其余1例在急诊科给予面罩吸氧，10小时后症状明显改善。均未使用利尿剂、糖皮质激素或强心剂。2例在治疗后24小时内、另2例在24 - 48小时内进行胸部X线检查；几乎所有肺部浸润影均消失。4例均治愈。气道梗阻的原因分别为：2例为气道异物，1例为喉痉挛，1例为喉软化。
NPPE是一种危及生命的急症，表现为气道梗阻解除后迅速（通常在数分钟内，但也可能在数小时后）出现呼吸窘迫，胸部X线表现为肺水肿。及时给予氧疗，无论是否进行机械通气，症状均可迅速缓解。对于气道梗阻的患儿，应考虑NPPE的可能。
