淡水近淹溺36例临床综合救治分析

Analysis of clinical comprehensive treatment of 36 cases with fresh water near - drowning

目的研究淡水近淹溺患者的临床表现、综合救治方法及患者的预后。方法回顾性分析1999-12～2009-12收住的36例淡水近淹溺患者的临床资料。结果淡水近淹溺的临床表现根据溺水时间、溺水后救治方法和送院时间的不同而表现各异，主要表现为不同程度的呼吸困难，严重时可伴有发绀、心动过速、四肢湿冷、血压下降、意识障碍、呼吸窘迫和咳粉红色泡沫样痰等。经综合救治后31例痊愈出院（86．1％）；死亡5例（其中1例因肺部严重感染死亡，2例因呼吸衰竭死亡，2例因多器官功能衰竭死亡），死亡率为13．9％。结论淡水近淹溺病情危重，死亡率高。如能早期及时得到合理有效的综合治疗，生存率较高。溺水后现场的正确急救和迅速护送，尽早机械通气，改善呼吸，早期、短程、足量的激素应用，早期有效的脑复苏，强有力的抗感染，保持水、酸碱、电解质平衡是抢救成功不可缺少的有效措施。

Objective To study clinical manifestation, comprehensive treatment and prognosis of patients with fresh water near - drowning. Methods To retrospectively analyze clinical information of 36 cases with fresh water near - drowning from December 1999 to December 2009. Results The mean age of 36 cases was 52.4 （ 12 - 71 ） and the male - female ratio was 2.3 ： 1. The different clinical manifestation of patients were based on drowning time, treatment methods after drowning and time of sending to hospital. Major clinical features were different degree of dyspnea, and could be accompanied by cyanosis, taehycardia, cold clammy extremities, hypotension, consciousness disturbances, respiratory distress, pink and frothy sputum, etc. After comprehensive treatment of total 36 patients, 31 （86.1% ） were fully recovered and discharged. 5 （ 13.9 % ） died and the cause of death were 2 cases with serious pulmonary infection, 2 with respiratory failure and 1 with multiple organ functional failure, respectively. Conclusion Patients with fresh water near - drowning was emergency and high mortality. Reasonable, effective and comprehensive treatment could improve survival rate including correct field first - aid treatment, immediate escort, as early as possible mechanical ventilation and improvement of breathing function, early and short -term and adequate hormone.