开胸术后发生急性呼吸窘迫综合征的病因探讨及治疗

Pathogenicity and treatment of acute respiratory distress syndrome after thoracotomy

目的 探讨开胸术后发生急性呼吸窘迫综合征 (ARDS)的原因及防治措施。 方法回顾分析 1993年 7月～ 2 0 0 1年 4月 ,31例开胸患者术后发生ARDS的发病特点 ,可能的原因及防治方法。 结果 有长期慢性肺部疾患、大量吸烟、原发性高血压病的患者 ,术后容易发生ARDS。肺部感染、休克和手术肺损伤是发生ARDS的 3大诱因。治疗应积极清除呼吸道分泌物、保持气道通畅、控制感染、利尿减轻肺水肿 ,尤其是尽早行气管插管或气管切开机械辅助通气是抢救成功的关键。结论 开胸术后患者发生ARDS的原因复杂 ,其中肺部感染、休克和手术肺损伤可能是主要原因 ,早期积极的治疗有望降低ARDS患者的病死率。

Objective To investigate the causes of acute respiratory distress (ARDS) after thoracotomy and to find out the measures to prevent ARDS. Methods The characteristics of incidence, pathogenicity and treatment of ARDS after thoracotomy in 31 patients were analysed. Results The patients who had chronic obstructive pulmonary disease, long history of smoking, hypertension were prone to ARDS. Injury to lung in operation, shock and pulmonary infection probably caused ARDS. Clearing away respiratory tract secretion, preserving of a clear airway, controlling pulmonary infection, alleviating pneumonedema by diuresis, early executing tracheotomy or mechanic assistant ventilation by tracheointubation were keys to rescuing patients successfully. Conclusions It is suggested that multi factors were related to ARDS after thoracotomy. Shock, injury to lung in operation, pulmonary infection, are important factors that lead to post-operative ARDS after thoracotomy. Early treatment can reduce mortality of ARDS.