中度高原急性呼吸窘迫综合征的氧缺陷类型

TYPES OF OXYGEN DEFECT OF ACUTE RESPIRATORY DISTRESS SYNDROME AT ALTITUDE OF 2 260m

目的:探寻中度高原地区急性呼吸窘迫综合征(ARDS)的氧缺陷类型;方法:对西宁地区海拔(2 260m)32例ARDS患者进行血液动力学及血气分析、测定心排指数(CI)、循环阻力(SVRI)、氧输送(DO)、氧消耗(VO)、氧摄取率(ER)以及临床一般资料进行分析;结果:ARDS血液动力学早期表现为高心排指数、低系统阻力,绝大多数表现高氧耗型氧缺陷,随着病情进展,成活组CI、SVRI趋于正常,死亡组则表现持续高动力循环,氧缺陷表现为低氧供型;病程晚期成活组CI、SVRI、DO、VO正常,死亡组仍呈高动力循环;讨论:DO下降,但不伴ER的代偿性增高,出现低氧供型和病理性氧依赖是ARDS的主要死亡原因。

Objective:To explore the types of oxygen defect of acute respiratory distress syndrome(ARDS) at altitude of 2 260m. Methods: 32 subjects, who suffered from ARDS, have been given hemodynamic monitoring and blood gas analysis, such as cardiac index (CI), systemic vascular resistance index (SVRI),oxygen delivery(DO),oxygen consumption(VO),oxygen uptaking rate(ER)were measured. Results: The changes of hemodynamics characterized high CI and low SVRI in the early stage of ARDS,and the most patients characterized high oxygen consumptive defect; the CI and SVRI tended to be normal gradually in live group but sustained hyperdynamic circulation in died group, the oxygen defect was low oxygen supply defect in progressive stage; the CI,SVRI,EX),and VO were normal in live group, whereas its also characterized hyperdynamic circulation and decrease of IX) but no compensatory increase of ER in died group in the late stage of ARDS. Conclusion: Low oxygen supply and pathologic oxygen dependence were the major causes of death of ARDS.