90例高海拔地区创伤性急性呼吸窘迫综合征的诊治体会——高海拔地区急性呼吸窘迫综合征诊断标准的探讨

Clinical investigation on the diagnosis and treatment of posttraumatic acute respiratory distress syndrome at high altitude:a review of 90 cases

目的 :研究高海拔 (2 2 6 0 m )地区严重创伤引起的急性呼吸窘迫综合征 (ARDS)的诊断标准。方法 :观察连续收治的 90例高海拔地区 ARDS的临床特征、动脉血气变化、X线胸片改变 ;并与平原 ARDS的诊断标准比较。结果 :高海拔地区创伤性 ARDS患者临床特征是 :1严重呼吸困难或窘迫 ,本组呼吸频率 38～74次 / min,平均 41次 / m in。 2严重紫绀 ,本组血氧饱和度 0 .2 3～ 0 .5 7(平均 0 .34)。 3严重低氧血症 ,Pa O2 2 .2～ 6 .0 k Pa(平均 3.6 k Pa,1k Pa=7.5 mm Hg)。4早期呼碱 ,Pa CO2 <1.5 k Pa,晚期呼酸 ,Pa CO2 >10 .0 k Pa。5氧合指数 (Pa O2 / Fi O2 ) 10 .6～ 2 5 .0 k Pa(平均 13.7k Pa)。6肺泡动脉氧压差 (PA a O2 ) 6 0～ 6 3k Pa(平均 5 8k Pa)。7双肺闻及大量的湿性口罗音和广泛性支气管哮鸣音。 8X线胸片示双肺大片状或云雾状渗出阴影。本组死亡2 3例 ,病死率 2 5 .6 %。结论 :高海拔地区 ARDS患者临床上有它特殊的症状体征 ,特殊的动脉血气变化与 X线胸片的改变。与平原 ARDS相比 ,差异显著。因此 ,建议应尽快建立合理实用的高海拔

Objective:To study and establish the diagnostic criteria for the acute respiratory distress syndrome (ARDS) complicating severe trauma at high altitude.Methods:Ninety patients suffered from posttraumatic ARDS at high altitude in our hospital were included in the study.The clinical characteristics,blood gas analysis and the Xray signs were analyzed.Comparison was made between the diagnostic criteria and treatment at high altitude and those on plain.Results:The clinical features of patients with posttraumatic ARDS at high altitude included:①severe dyspnea or respiratory distress with the respiratory rates between 3874 per minute (mean:41 per minute);②prominent cyanosis with arterial oxygen saturation(SaO 2) between 0 230 57 (mean:0 34);③obvious hypoxemia with PaO 2 between 2 26 0 kPa (1 kPa=7 5 mmHg;mean: 3 6 kPa );④respiratory alkalemia (PaCO 2<1 5 kPa) in early stage and respiratory acidosis (PaCO 2> 10 0 kPa ) in late stage;⑤PaO 2/FiO 2 ratio was between 10 625 0 kPa (mean:13 7 kPa);⑥alveolararterial oxygen tension difference was between 6063 kPa(mean:58 kPa);⑦widespread moist rales and wheezing by auscultation in lungs on both sides;⑧hazy shadows on chest Xray film indicating exudation.The mortality of the patients in this group was 25 6 %.Conclusions:The clinical signs and symptoms,as well as blood gas analysis results and Xray signs of the patients who suffered ARDS at high altitude were significantly different with those in patients on plain.Hence,a more precise and practicable diagnostic criteria for such patients is in urgent need.