重度烧伤并发急性呼吸窘迫综合征相关因素及诊治研究

目的总结重度烧伤后并发ARDS的相关因素及预防、诊断治疗经验。方法回顾性分析2003年1月至2008年12月间收治的烧伤并发ARDS患者的临床治疗资料及结果。结果5年间该院烧伤科共收治重度烧伤的成人297例，并发ARDS32例，发病率为11％；发病时间高峰为伤后4～12d；重度吸人性损伤、脓毒血症、延迟复苏等为ARDS发病的高危因素。32例中，治愈23例，死亡9例，病死率28％。结果重度烧伤后ARDS仍有较高病死率，预防重点在于保持呼吸道的通畅、早期复苏、及早切（削）痂植皮和防治脓毒血症等综合措施。治疗关健在于早诊断和机械通气，PEEP是必不可少的通气方式，是治疗的重要内容，深度创面的手术等原发病的处理是治疗的根本。

Objective To summary the related factor, prevention, diagnose and treatment experience after the heavy degree burn coincidence ARDS. Methods We reviewed and analyzed the clinical treatment data and results about the burn coincidence ARDS during 2003 January to 2008 December. Results 297 examples with heavy degree＇ s burn patients were cured in our hospital during the five years and coincidence ARDS was 32, outbreak rate was 11%. The high peak of the outbreak time was 4 to 12 days after injure. The high danger factors for ARDS were heavy hurt, delay resuscitation and etc. In 32 examples, 9 were dead and the death rate was 28%. Conclusions Coincidence ARDS after heavy degree burn still has high death rate and the prevention point is keeping the breath way lucid, recovering the crust in early and preventing pyemia etc. The key point of curing is early diagnose and mechanical ventilation. PEEP is an essential way of mechanical ventilation and is the important content of treatment. The root treatment is curing the original outbreak of heavily wound surface.