限制补液在胸外伤继发急性肺损伤或急性呼吸窘迫综合征治疗中的应用

Application of restrict rehydration in treatment of chest trauma complicated with acute lung injury or acute respiratory distress syndrome

目的：总结限制补液在胸外伤合并急性肺损伤（ ALI）或急性呼吸窘迫综合征（ARDS）治疗中的应用效果。方法单纯胸外伤合并 ALI 或 ARDS 患者132例，采用限制补液技术，适当减少补液，加控制性降压技术，收缩压控制在95-110 mmHg 之间，早期以维持一个满足基本灌注的偏低血压作为目标血压，减少输液量和速度。通过单纯胸部外伤（排除其他部位重症损伤的干扰）的救治，总结呼吸窘迫防治特点。结果 ALI/ ARDS 气管插管率为17.4%（23/132），气管切开的发生率为3.8%（5/132），死亡率为2.3%（3/132）。结论 ALI 时不恰当的补液过多引发肺水肿是单纯胸外伤并发 ARDS 主因，而不是反常呼吸所致。适当控制输液，辅以控制性降压技术能大大降低重症胸外伤死亡率。

Objective To summarize the effects of restrict rehydration in treatment of chest trau-ma complicated with acute lung injury（ALI）or acute respiratory distress syndrome（ARDS）. Methods Selected 132 cases of patients with simple thoracic trauma complicated with ALI or ARDS. The patients were treated by restricting rehydration,reducing fluid infusion appropriately,combining with controlled hy-potension to control systolic pressure between 95-110 mmHg. Maintained a low blood pressure to meet the basic perfusion need as the target blood pressure,reducing the quantity and speed of infusion. Summarized the characteristics of respiratory distress in the treatment of thoracic trauma（excluding the interference of other parts of severe injury）. Results The incidence rate of ALI/ ARDS intubation was 17. 4%（23 /132）,tracheotomy was 3. 8%（5 / 132）,mortality was 2. 3%（3 / 132）. Conclusion ALI combined with inappropriate fluid infusion lead to pulmonary edema is the main cause of ARDS,not the abnormal breath-ing. The death rate of refractory ARDS can be greatly reduced by controlled hypotension.