西宁地区严重创伤患者并发成人呼吸窘迫综合征氧动力学变化

Oxygen dynamic change in severely injured patients complicated with acute respiratory distress syndrome in Xining area

目的 探讨西宁地区严重创伤后并发成人呼吸窘迫综合征（ＡＲＤＳ） 时氧动力学变化，为治疗提供理论依据。 方法 利用Ｓｗａｎ － Ｇａｎｚ 导管及热稀释法心输出量测定技术对２０ 例ＡＲＤＳ患者进行监测。 结果 （１） 监测开始１ ～２ ｄ 存活组和死亡组的氧输送（ＤＯ２） 逐渐上升，氧耗量（ＶＯ２） 也随之上升，出现病理性氧供依赖（ｒ＝ ０．６１７６，Ｐ＜ ０．０５） ，两组间比较无显著性差异。（２）抢救４～５ ｄ 以后，存活组患者ＤＯ２ 仍继续升高，ＶＯ２ 也升高（ｒ＝ ０．６５４７，Ｐ＜ ０ ．０５） ，但当ＤＯ２ 达到７００ ｍｌ·ｍｉｎ－ １·ｍ － ２ 时，ＶＯ２ 上升缓慢，出现“平台效应”，而死亡组尽管临床上最大限度地提高了ＤＯ２ ，但ＶＯ２ 仍与ＤＯ２ 呈病理性依赖（ｒ＝０．７４９３，Ｐ＜ ０．０５） 。（３） 两组的氧摄取率（Ｏ２ｅｘｔ） 在整个监测期间均处于较低水平。 结论 严重创伤后ＡＲＤＳ患者氧摄取已出现明显障碍，从而导致ＶＯ２对ＤＯ２ 发生氧供依赖，在治疗中应当将ＤＯ２ 水平尽可能提高到７００ ｍｌ·ｍｉｎ－ １·ｍ － ２ 以上。

Objective To discuss the changes of oxygen delivery in the severely injured patients complicated with acute respiratory distress syndrome (ARDS) in Xining. Methods Twenty severely injured patients complicated with ARDS were monitored by Swan Ganz catheter and thermodilution . Results The oxygen delivery (DO 2) and oxygen consumption (VO 2) of both the survival group (Group S) and the death group (Group D) increased in 1 2 days. A pathological oxygen supply dependence emerged ( r =0.6176, P < 0.05) . However, there were no significant differences between Group S and Group D. After 4 5 days of treatment, VO 2 and DO 2 in Group S increased ( r =0.6547, P <0.05). When DO 2 reached 700 ml·min -1 ·m -2 ,VO 2 increased slowely, and then a “platform effect” occurred. The oxygen extraction rate (O 2ext) in both groups was low during the monitoring. Conclusions The compensation functions of the O 2ext in the severely injured patients complicated with ARDS show obvious disorders which leading to the oxygen supply dependence of VO 2 to DO 2. Therefore, it suggests that DO 2 should reach 700 ml· min -1 ·m -2 or more in the treatment.