急性呼吸窘迫综合征临床诊断及规范治疗体会

Clinical diagnosis and standardized treatment of acute respiratory distress syndrome

目的：探讨急性呼吸窘迫综合征（ARDS）的诊断方法及规范化的治疗手段，以期提高治疗安全性、科学性和有效性。方法选取2013年3月~2014年6月收治的符合 ARDS 诊断标准的患者共105例，观察组给予符合肺保护通气策略的规范化综合治疗，增加个体化设置小潮气量通气、俯卧位通气等改善策略；对照组给予人工机械通气为主的常规综合治疗。结果①治疗3 d 后，观察组的 R 和 P 治疗前后间差异无统计学意义（P 〉0.05），观察组 SaO 2、PaO 2、氧合指数（PaO 2/FiO 2）明显高于对照组（P 〈0.05）。②治疗10 d 后，观察组治疗有效率为93.65%；对照组为76.19%。两组患者的临床疗效经统计学分析差异有统计学意义（P 〈0.05）。结论 ARDS 病情危急，及时正确诊断、规范有效治疗是提高救治率、降低病死率的重要保证。

Objective To investigate the diagnosis and standardized treatment of acute respiratory distress syndrome （ARDS）,so as to improve treatment safety,science and effectiveness. Methods From March 2013 to June 2014,105 patients diagnosed with ARDS were admitted to our department.Patients of the obser-vation group were given consistent with lung protective ventilation strategy standardized comprehensive treat-ment,added individual prescription of low tidal volume ventilation,prone position ventilation and other im-proved strategy;patients of the control group received conventional comprehensive treatment majoring in artifi-cial mechanical ventilation. Results ①Three days after treatment,comparing pre-treatment R and P levels to those of post-treatment for the observation group yielded no statistically significant difference （P 〉0.05）. Patients in the observation group had significantly higher SaO 2 ,PaO 2 and oxygenation index （PaO 2/FiO 2 ） than those in the control group （P 〈0.05 ）.②Ten days after treatment,the response rate for observation group was 93.65%,but the control group was only 76.1 9%.,group-paired comparison of clinical effective-ness showed a statistically significant difference （P 〈 0.05 ）. Conclusion ARDS is a critical disease,and timely accurate diagnosis and standardized effective treatment is effective and guarantee to improve the curative rate and to reduce the mortality.