创伤性成人呼吸窘迫综合征的诊治体会

Experience from 33 cases of adult repiratery distresssyndrome due to trauma

就１３４８例严重创伤患者所发生的３３例成人呼吸窘迫综合征（ＡＲＤＳ）的诊治情况，探讨了与ＡＲＤＳ发生相关的因素。资料显示创伤的类型、特别是胸部创伤与ＡＲＤＳ发生有明显的相关性。作者强调诊断上怀疑ＡＲＤＳ发生患者必须在ＩＣＵ严密监测。本组所应用的创伤性ＡＲＤＳ发生指数公式Ｉ＝ＰＦ－（Ｎ＋Ｔ＋Ｆ＋Ｍ＋Ｘ）对ＡＲＤＳ的早期确诊和提示病情发展趋势很有帮助；治疗上要掌握好抗休克与ＡＲＤＳ的关系，胸部外伤和全身的关系；要以提高氧输送和氧摄取为重点，具体要落实于提高氧饱和度和心排出量上。同时作者还介绍了呼吸机疗法对创伤性ＡＲＤＳ患者的应用。

33 cases of aduit respiratory distress syndrome(ARDS ) occurred in 1 348 patients with serious traumawere studied.The result showed that the occurrence ofARDS was related to the type and the severity of trau-ma , particulary related to chest trauma.A formula con-cerning the occurrence index of ARDS with trauma ispresented as follows:I=PF -(N+T+F+M+X).Theformula is helpful for the diagnosis and the prediction ofthe tendency of the dieease. Once the patient is suspectedto have ARDS,he should be referred to the intensivecare unit for close monitoring and timey treatment. Theimportance of management of shock and chest traumawas indicated and the importance of improving the DO_2(oxygen delivery)and VO_2(oxygen uptake), raising theSaO_2(oxygen saturation ) and CO (cardiac output) wasstressed. The application of mechanical ventilation inARDS with trauma was discussed.