高原肺水肿继发急性呼吸窘迫综合征氧动力学变化特点及治疗

Treatment of high altitude pulmonary edema combined with secondary adult respiratory distress syndrome and monitoring of oxygen dynamics

目的:探讨高原肺水肿继发急性呼吸窘迫综合征氧动力学变化特点及治疗方法。方法:采用右心漂浮导管及热稀释法,对8例高原肺水肿继发急性呼吸窘迫综合征患者进行了氧动力学监测,并提出治疗方法。结果:监测开始时,右房压(RAP)、肺动脉平均压(mPAP)、肺循环阻力指数(PVRI)、肺内分流(Qs/Qt)明显增加,心输出指数(CI)、氧输送(DO2)、氧耗量(VO2)、氧摄取(O2ext)、氧合指数(PaO2/FiO2)明显减低;监测结束时,RAP、mPAP、PVRI、Qs/Qt明显减低(P<0.05),而CI、DO2、VO2、O2ext、PaO2/FiO2明显增加(P<0.05),8例患者全部存活。结论:高原肺水肿继发急性呼吸窘迫综合征时氧动力学已发生明显紊乱,病情危重,治疗的关键是早期机械通气,提高氧输送,改善组织氧合。

Objective： To investigate the changed characteristics of oxygen dynamics and treatment strategies of high altitude pulmonary edema（HAPE） combined with secondary acute respiratory distress syndrome（ARDS）.Methods： The data of oxygen dynamics in 8 HAPE patients with secondary ARDS were monitored with Swan-Ganz catheter,and the treatment methods were analyzed.Results： At the beginning of monitoring,the data of RAP,mPAP,PVRI and Qs/Qt increased significantly,and the data of cardiac output index（CI）,oxygen delivery（DO2）,oxygen consumption（VO2）,oxygen extractionrate（O2ext） and PaO2/FiO2 decreased significantly.At the end of monitoring,the data of RAP,mPAP,PVRI,PVRI and Qs/Qt decreased significantly（P〈0.05）,and the data of CI,DO2,VO2,O2ext and PaO2/FiO2 increased significantly（P〈0.05）.All of the 8 patients survived.Conclusion： The data of hemodynamics and oxygen dynamics in HAPE patients with secondary ARDS are greatly disordered.Early mechanical ventilation is the most important treatment measure for improving hypoxia and enhancing oxygen delivery.