重症急性胆管炎并发急性呼吸窘迫综合征的治疗

Treatment of Severe Acute Cholangitis Complicated by Acute Adult Respiratory Distress Syndrome

目的总结重症急性胆管炎(ACST)并发急性呼吸窘迫综合征(ARDS)患者的临床治疗与诊治效果。方法回顾性分析1997—2007年收治的326例ACST患者中73例并发ARDS患者的临床资料及诊治效果。结果本组ACST患者中ARDS的发生率为22.4%(73/326),ARDS发生的时间为发病后48h～7d,平均3.8d。73例均使用了呼吸机治疗,呼吸机使用时间4～12d。治愈65例,治愈率89.1%。结论在ACST的急性反应期应反复测定血气分析,可早期诊断ARDS。一旦出现难以纠正的低氧血症,及时行气管插管或气管切开辅助呼吸,可以明显改善缺氧状况,是提高重症急性胆管炎(ACST)治愈率的有效措施。

Objective To explore the diagnosis and treatment of severe acute cholangitis （ACST） complicated by adult respiratory distress syndrome （ARDS）. Methods Retrospective analysis was performed on clinical data of 326 ACST patients admitted from Jan. 1997 to Dec. 2007, 73 of whom were complicated by ARDS. Results ARDS incidence of this group of ACST patients was 22. 4% （73/326）, the genetic time of ARDS was 48 h - 7 d after disease onset, with an average of 3. 8 d. All of 73 patients were treated with breathing machines for 4 - 12 d. Sixty - five were cured, with a cure rate of 89. 1%. Eight died. Conclusion We must assay blood gas repeatedly during acute response period of ACST to give early diagnosis of ARDS. Once hard - corrected hypoxemia appeared, intubation or tracheostomy, an effective measure of increasing cure rate of ACST, must be carried out in time, thus to improve significantly the situation.