多发伤者急性呼吸衰竭的抢救(附34例分析)

Treatment of acute respiratory failure in polytrauma patients

目的通过对严重多发创伤患者的病例分析，指出重视临床早期判断急性呼吸功能障碍和急性呼吸衰竭的重要性，并提出延时使用呼吸机对呼吸衰竭的抢救。方法分析３４例多发伤引起的急性呼吸衰竭者。结果７９４％患者使用呼吸机。其中，Ⅰ型呼吸衰竭者以延时使用为主，占８０％（１２／１５）；Ⅱ型呼吸衰竭者以即刻使用为主，占５８３％（７／１２）。呼吸监测指标（Ｓｐｏ２、呼吸频率及ＥＴｃｏ２）：入院时即刻使用呼吸机者与延时使用呼吸机者相比、延时使用呼吸机者出现急性呼吸衰竭时与入院时相比，都有显著意义（Ｐ＜００１）。结论多发伤者在呼吸监测过程中，若未出现急性呼吸衰竭的状况，无需过早使用机械通气手段。合并有颅脑外伤的多发伤者，其Ⅱ型呼吸衰竭的发生率较高，且多数要依靠即时的机械通气；在胸外伤合并其它外伤和非颅脑、非胸外伤的多发伤患者中，延时使用呼吸机者占很大比率（７３３％）。

Objective To emphasize the importance of the early diagnose of acute respiratory dysfunction(ARD) and acute respiratory failure(ARF) by analysing cases of severe polytrauma patients.The viewpoint that the application of ventilator should be delayed is also put forward.Methods Analyse 34 cases of ARF accompanied by polytrauma.Results 79.4% of patients are treated by ventilator,among whom the majority of type I ARF(80%,12/15)are delayed in appoication of ventilator,while the majority of type Ⅱ (68.3%,7/12) are managed immediately.Respiratory monitoring parameters(Spo 2,respire rate and ETco 2) are compared.The ratios of the immediately used and the delayed used,the delayed used when in ARF and their admission history both have prominent difference( P <0.01) Conclusion Polytrauma patients without evidence of ARF need not be treated by ventilators when they are in respiratory monitoring.The majority of polytrauma patiens with head injury need to be managed by ventilator immediately,most of whom suffer from type Ⅱ ARF.But the majority of polytrauma patients with thorax inuury and those without head injury and thorax injury (73.3%) are delayed in the management of ventilator. [