机械通气治疗放疗导致的ARDS的疗效及评价  

Therapeutic effect and evaluation of mechanical ventilation treatment on ARDS caused by radiotherapy

作　　者：朱贵月[1] 解建[1] 魏长良[2] 姜志明[1] 徐拥庆[1] 李涛[1] 邱洁[1] 张淑香[1] 

机构地区：[1]山东大学临床医学院山东省千佛山医院ICU,山东济南250014 [2]山东省立医院

出　　处：《中国急救医学》2004年第7期474-475,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　研究机械通气治疗恶性肿瘤放疗导致的ARDS患者临床疗效、并发症及预后 ,进一步提高该类患者的生存率。方法　 4 7例患者中 ,恶性肿瘤放疗导致ARDS患者 15例 ,其他原因导致ARDS 32例 ,比较放疗组和非放疗组机械通气前后氧合情况、机械通气并发症和住院期间死亡率。结果　两组患者机械通气后 12、4 8h时PaO2 、氧合指数均比治疗前显著改善 (P <0 .0 1) ,但放疗组在机械通气后 72h时PaO2 、氧合指数与治疗前无明显差异 (P >0 .0 5 ) ;与放疗组相比 ,非放疗组机械通气后 12、4 8、72h时PaO2 、氧合指数改善更为显著 (P <0 .0 1)。放疗组气胸、呼吸机相关性肺炎 (VAP)、多器官功能障碍综合征 (MODS)发生率均显著高于非放疗组 (P <0 .0 1)。放疗组住院期间死亡率显著高于非放疗组 (P <0 .0 1)。结论　恶性肿瘤放疗导致的ARDS患者预后极差 ,机械通气只能短暂应用于该类患者急救 ,并不能改善预后。Objective To study the clinical effect,complications and prognosis of mechanical ventilation treatment on the patients with ARDS who were given radiotherapy because of malignant tumor in order to enhance survival rate of these patients. Methods The state of blood oxygen before and after mechanical ventilation, complications of mechanical ventilation and death rate in hospitalization were compared between 15 patients with ARDS caused by radiotherapy and 32 patients with ARDS caused by other reasons. Results The state of blood oxygen after mechanical ventilation: PaO 2,PaO 2/FiO 2 at 12, 48 h after mechanical ventilation were improved significantly compared with before mechanical ventilation(P<0.01),but index at 72 h after mechanical ventilation weren't different significantly in comparison with before therapy (P>0.05)in radiotherapy group. PaO 2,PaO 2/FiO 2 at 12, 48, 72 h after mechanical ventilation in non-radiotherapy group were improved significantly compared with radiotherapy group(P<0.01).The incidence of mechanical ventilation complications: the incidence pneumothorax, VAP and MODS in radiotherapy group were higher significantly than non- radiotherapy group(P<0.01). Death rate of hospitalization in radiotherapy group were higher significantly than non- radiotherapy group(P<0.01). Conclusion Mechanical ventilation didn't improve prognosis of patients with ARDS caused by radiotherapy, to prevent from ARDS is key for patients receiving radiotherapy.[

关 键 词：恶性肿瘤 放射性治疗 急性呼吸窘迫综合征 机械通气 

分 类 号：R730.5[医药卫生—肿瘤]