急性胆囊炎伴2型糖尿病术后急性呼吸窘迫综合征临床分析

Clinical analysis of postoperative acute respiratory distress syndrome in patients with acute cholecystitis and type 2 diabetes mellitus

目的探讨急性胆囊炎伴2型糖尿病术后急性呼吸窘迫综合征的发病原因及治疗方法。方法收集2009年1月至2011年9月普外科收治的急性胆囊炎伴2型糖尿病的123例行外科手术后发生急性呼吸窘迫综合征(ARDS)的4例患者进行临床观察分析。结果 123例患者行外科手术后,4例发生ARDS,其中1例发生呼吸衰竭后抢救无效死亡。平均静脉滴注量为4 601 mL,最多7 800 mL;平均手术时间为5.32 h;平均静脉滴注普通胰岛素为31.5 U;发生休克者3例(2.44%);术后均有肺部感染及胃肠减压留置。结论静脉滴注过多、术后肺部感染、内毒素血症等原因是引起ARDS的主要原因,因此,在手术过程及术后采取积极的防治措施,及时去除感染病灶、控制静脉滴注量等,对术后ARDS的发生及治疗产生积极的作用。

Objective To explore the causes and treatment methods of postoperative acute respiratory distress syndrome （ARDS） in patients with acute cholecystitis and type 2 diabetes mellitus（T2DM）. Methods 123 patients with acute cholecysti- tis and T2DM enrolled in general surgery department from January 2009 to September 2011 were collected ,4 cases of which with postoperative acute respiratory distress were analyzed clinically. Results After the 123 patients underwent operation,4 cases were with ARDS, 1 case of which died after rescue. The average amount of intravenous drip was 4 601 mL with the most of 7 800 mL; the average time of operation was 5.32 hours ; the average amount of soluble insulin dripping was 31.5 U ; shock occurred in 3 case accounting for 2.44% ; all patients were with pulmonary infection and retention of gastrointestinal decompression after operation. Conclusion Excessive transfusion,postoperative pulmonary infection,endotoxemia caused by other reasons are the main rea- sons for ARDS, so taking active preventive measures during and after operation timely to remove foci of infection, control the fluid volume and so on have a positive effect on postoperative occurrence and treatment of ARDS.