胸外伤诱发急性呼吸窘迫综合征100例临床诊治分析

Clinical diagnosis and treatment analysis of chest trauma-induced acute respiratory distress syndrome in 100 patients

目的探讨胸部外伤诱发呼吸窘迫综合征(ARDS)的临床特点及治疗方法,为其诊断和治疗提供理论依据。方法对100例胸外伤发生ARDS的临床资料进行分析,并将所有患者随即分为治疗组和对照组各50例,治疗组给予小潮气量通气,对照组给予常规潮气量通气,观察两组治疗效果及血气分析。结果年龄≥60岁,呼吸频率≥28次∕min,收缩压≥12kPa,肋骨骨折≥4处,伴有肺挫伤和腹腔内脏器损伤及ISS值≥16与胸外伤发生ARDS密切相关(P<0.01),治疗组VILI、VAP、MODS及死亡例数明显低于对照组,并且通气时间明显少于对照组,差异均有明显的统计学意义(P<0.01)。结论高龄、呼吸困难、高血压、多发肋骨骨折、肺挫伤,、腹腔内脏损伤、是影响胸外伤并发ARDS的高危因素,低潮气量机械通气适合ARDS患者应用。

Objective To investigate the clinical diagnosis and treatment analysis of chest trauma induced respiratory dis- tress syndrome （ARDS） , to provide a theoretical basis for its diagnosis and treatment. Methods Analysis of clinical data of 100 patients with chest trauma induced ARDS, and all patients were randomly divided into the treatment group and the control group, 50 patients, the treatment group received low tidal volume ventilation, the control group was given conventional tidal volume venti- lation treatment were observed effect and blood gas analysis. Results Age ≥60 years of age ≥ 28 times / rain, respiratory rate, systolic blood pressure ≥ 12kPa, rib fractures ≥4, ≥ 16 with chest trauma and the development of ARDS associated with pulmona- ry contusion and abdominal visceral injury and ISS values closely related （P 〈 0. 01 ）, treatment group distension by the high air- way pressure, VAP, MODS, and the number of deaths was significantly lower than the control group, and the ventilation time was significantly less than that of the control group, the differences were statistically significant （ P 〈 0. 01 ）. Conclusion High age, dyspnea, muhi-fracture of rib, pulmonary contuse, injury of abdomen organs, complications of respiratory system and levels of ISS are high risk factors influencing ARDS after thoracic trauma. The mcchanicalventilation with low volume plus PEEP fails to improve effect of oxygenation in the course of treatment of ARDS after thoracic trauma.