分化综合征合并急性呼吸窘迫综合征的临床诊治分析

Diagnoses and Treatment of Differentiation Syndrome Complicated with Acute Respiratory Distress Syndrome

目的分析分化综合征合并急性呼吸窘迫综合征的临床特点。方法选取2005年5月—2011年10月我院收治的分化综合征合并急性呼吸窘迫综合征患者8例,回顾性分析患者的临床症状、实验室检查结果、治疗及预后。结果 8例患者主因发热、乏力、出血等就诊于我院血液科,确诊为急性早幼粒细胞白血病后应用维A酸诱导治疗,均出现呼吸急促、困难,高热;4例患者体质量增加超过5 kg,2例患者出现低血压,1例患者出现肾功能不全。5例患者行胸部X线检查,表现为两肺纹理增粗、模糊,散在片状影,大小不一,边缘不清,或片状影融合呈弥漫渗出性改变,3例患者行胸部CT检查,可见两肺多发片状及磨玻璃样高密度影,边界欠清,其中2例患者可见下肺不张或胸腔积液。均给予经口气管插管,呼吸机辅助呼吸,4例患者经治疗后病情好转,氧合指数升高,胸部X线示肺部渗出吸收,予呼吸机辅助呼吸治疗10～18 d后查血气分析基本正常,肺部渗出大部分吸收,脱离呼吸机,拔除气管插管,经后续治疗后达到临床缓解。2例患者低氧血症难以纠正,1例患者并发双侧气胸,1例患者并发弥散性血管内凝血,均治疗无效死亡。结论分化综合征合并急性呼吸窘迫综合征一旦发生,病死率极高,其预后与早期诊断、早期合理治疗关系密切。

Objective To analyze the clinical features of differentiation syndrome （DS） with acute respiratory distress syndrome （ARDS）. Methods The clinical data including clinical presentations, laboratory findings, treatment and prognoses of 8 DS patients with ARDS who were treated in our hospital from May 2005 to October 2011 were retrospectively analyzed. Resuits The onset symptoms included fever, fatigue, and bleeding. Patients were treated with induction therapy with retinoic acid, and then developed shortness of breath, difficulty in breathing, and high fever; Body weight increased by 〉 5 kg in d patients, and two patients developed hypotension and one suffered from renal dysfunction. In 5 patients, chest X - ray showed thickened and blurred lung texture, with diffuse patchy cloudy shadows of various sizes ; The borders were unclear, or the patchy shadows fused and showed diffuse exudative changes. Three patients received computed tomography （CT）, which showed multipie patchy or ground - glass like high - density shadows, with less clear borders. Atelectasis at the lower lung or pleural effusion was detected in 2 patients. All patients were given orotracheal intubation and mechanical ventilation. The condition was improved after treatment in 4 patients, with elevated oxygenation index; Chest X - ray showed the pulmonary exudate was absorbed. After 10 -18 days of mechanical ventilation blood gas analysis showed basically normal results, and the pulmonary exudate was absorbed. Patients were then withdrawn from the ventilator and extubated. Clinical response was achieved during the follow - up treatment. Two patients had non - adjustable hypoxia, 1 had concurrent bilateral pneumothorax, and 1 develped disseminated intravascular coagulation （DIC） ; All these four patients died. Conclusion DS with ARDS can have high mortality rate. There-for, early diagnosis, early intervention, and appropriate treatment are critical to improve the outcomes.