胸外伤后ARDS的呼吸治疗

Mechanical ventilation treatment on acute respiratory distress syndrome in severe thoracic trauma

目的探讨严重胸外伤后发生呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)的早期诊断和呼吸治疗。方法回顾分析62例胸外伤后ARDS的诊治过程。结果该组分成两组,传统机械呼吸+终末正压通气(PEEP)组39例,带机时间平均(6.2±1.6)d。死亡18例,病死率46.16%;呼吸机“肺保护性”通气组23例,带机时间平均(4.8±2.1)d,死亡6例,病死率21.09%。两组比较差异具有显著性(P<0.05)。结论早期诊断和及时治疗是该病治疗的关键,呼吸“肺机保护性”通气治疗ARDS比传统机械呼吸+PEEP效果更优越,同时积极处理原发损伤和预防各种并发症也很重要。

[Objective] To explore the diagnosis of severe thoracic trauma complicated by acute respiratory distress syndrome （ARDS） and mechanical ventilation treatment. [Methods] 62 cases of severe thoracic trauma complicated by acute respiratory distress syndrome were reviewed. 39 cases with traditional ventilation strategy, 23 cases with a protective ventilation strategy. [Results] Average ventilator-carried time of traditional ventilation strategy group was （6.2＋1.6） days and mortahty was 46.16 %. Average ventilator-carried time of protective ventilation strategy was （4.8±2.1） days and mortality was 21.09 %. [Conclusion] The key of ARDS is the early diagnosis and ventilation strategy. Protective ventilation strategy in treating ARDS is more effective compared with the traditional ventilation strategy. It can obviously shorten the ventilator-carried time and reduce the mortality of ARDS.