重症胸部损伤合并急性呼吸窘迫综合征的诊治分析

Analysis of Diagnosis and Treatment of Severe Chest Injuries Combined with Acute Respiratory Distress Syndrome

目的分析探讨对重症胸部损伤合并急性呼吸窘迫综合征(ARDS)患者的临床有效诊断及治疗措施。方法将2015年12月—2016年12月收治的41例重症胸部损伤合并急性呼吸窘迫综合征的患者作为研究对象,为患者进行机械通气治疗,并使用激素及血管扩张剂和相关对症治疗,分析比较治疗前后患者的血气分析即氧分压(Pa O2)、二氧化碳分压(Pa CO2)以及氧合指数(Pa O2/Fi O2),来对患者的诊断和治疗效果进行分析总结。结果治疗后患者的Pa O2、Pa O2/Fi O2分别为(91.2±3.7)、(362.1±29.1)mm Hg和治疗前的(51.3±5.2)、(138.2±21.3)mm Hg相比显著升高,Pa CO2为(47.2±2.1)mm Hg和治疗前的(25.1±1.6)mm Hg相比显著降低,且数据差异有统计学意义(t=9.825,P=0.017 2;t=18.281,P=0.009 1;t=13.927,P=0.012 8);患者的痊愈率为85.37%,死亡率为14.63%,主要死亡原因为多器官功能衰竭(MSOF)。结论对重症胸部损伤合并急性呼吸窘迫综合征患者进行及时早期诊断,尽早进行积极有效的机械通气和全身治疗可有效提高患者的抢救成功率。

Objective To analyze and study the clinical effective diagnosis and treatment measures of severe chest injuries combined with acute respiratory distress syndrome. Methods 41 cases of patients with severe chest injuries combined with acute respiratory distress syndrome admitted and treated in our hospital from December 2015 to December 2016 were selected, treated with mechanical ventilation, hormone, vasodilator and related systematic therapy, and the Pa O2, Pa CO2 and Pa O2/Fi O2 of patients before and after treatment were observed, and the diagnosis and treatment effect was analyzed and summarized. Results After treatment, the Pa O2, Pa O2/Fi O2 before and after treatment were respectively（51.3±5.2） mm Hg,（138.2±21.3）mm Hg and（91.2±3.7）mm Hg,（362.1±29.1）mm Hg, and the Pa CO2 obviously decreased compared with that before treatment[（47.2±2.1）mm Hg vs（25.1±1.6）mm Hg], and the difference was statistically significant（t=9.825,P=0.017 2;t=18.281,P=0.009 1; t=13.927,P=0.012 8）, and the cure rate of diseases and morbidity were respectively 85.37% and 14.63%, and the major death cause was the MSOF. Conclusion The timely and early diagnosis of patients with severe chest injuries combined with acute respiratory distress syndrome and positive and effective mechanical ventilation and general therapy can effectively improve the rescue successful rate of patients.