创伤性ARDS发生指数公式的应用及治疗

Clinical Application of Occurence Index Equation in Traumatic ARDS

就１１０３例严重创伤病人中所发生的２２例ＡＲＤＳ的诊治，探讨了与ＡＲＤＳ发生相关的因素。指出创伤的类型，特别是胸部创伤与ＡＲＤＳ发生有明显相关性。强调凡怀疑ＡＲＤＳ倾向病人必须放在ＩＣＵ严密监测，以早期诊断和治疗。诊断上提倡应用创伤性ＡＲＤＳ发生指数公式来监测分析。公式Ｉ＝ＰＦ－（Ｎ＋Ｔ＋Ｆ＋Ｍ＋Ｘ）。Ｉ：发生指数；ＰＦ：呼吸指数ＰａＯ２／ＦｉＯ２（氧分压／吸入氧浓度）之值，ＰａＯ２必须以ｋＰａ做单位；Ｎ：中枢神经系统损伤；Ｔ：胸外伤；Ｆ：骨折；Ｍ：输液和输血量；Ｘ：Ｘ光胸部平片。再将伤情用数值代人公式中，计算Ｉ值，若Ｉ＞１０，９５％不发生ＡＲＤＳ，Ｉ＜一２，９０％以上发生ＡＲＤＳ，Ｉ值在一２～１０之间，有呼衰可能，需严密监测。此公式对提示早期诊断和疾病发展趋势很有帮助。治疗上要掌握好处理原发伤和ＡＲＤＳ、抗休克与ＡＲＤＳ的关系，应以提高ＤＯ２（氧输送）和ＶＯ２（氧摄取）为重点，具体要落实到提高ＳａＯ２（血氧饱和度）和ＣＯ（心排出量）。同时，介绍了呼吸器疗法对创伤性ＡＲＤＳ病人的应用体会。

Twenty-two cases of ARDS among 1 103 severe injuried patients are discussed in this paper. The main related factors of ARDSoccurence were chest trauma. Patients with suspicious ARDS should be monitored carefully in ICU for early diagnosis and treat-ment. In diagnosing and evaluating the patients, we recommended the use of occurence index equation: I=PF-(N+T+F+M+X).Here I=occurence index; PF=PaO2 (kPa)/FiO2 : N=injury of central nervous system: T=chest trauma; F=fracture: M=amount offluid and blood transfusion: X=chest plane X-ray.If I> 10, about 95%patients will not have ARDS: if I<-2, more than 90%pa-tients will suffer from ARDS:if I is between-2and 10, respiratory failure may occur and careful monitor is needed. We should wellmanage the relationships between original injury and ARDS antishock and ARDS in treatment, put emphasis on increasing DO2,SaO2, CO.This paper also introduces the application of respirator in treating traumatic ARDS patients.