创伤性休克患者院前救治与术后急性肺损伤/急性呼吸窘迫综合征发生的相关性调查  

Investigation of relationship between prehospital care for traumatic shock and postoperative acute lung injury/acute respiratory distress syndrome

作　　者：史计月[1] 周琨[2] 张爱民[1] 耿岩[3] 张洪林[4] 侯宝君[1] 

机构地区：[1]河北工程大学附属医院麻醉科,056002 [2]河北工程大学附属医院普外科,056002 [3]邯郸市中心医院产科 [4]河北工程大学附属医院骨科,056002

出　　处：《中国危重病急救医学》2006年第9期535-538,共4页Chinese Critical Care Medicine

基　　金：河北省科技攻关基金资助项目(92216127D)

摘　　要：目的调查分析创伤性休克患者院前救治与术后急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的相关性及其临床意义。方法随机双盲法抽取1995年10月—2005年10月符合调查条件的创伤性休克患者600例,其中院前进行综合治疗184例(A组),单纯液体复苏治疗305例(B组),未治疗111例(C组)。对比各组全身炎症反应综合征(SIRS)、ALI/ARDS、多器官功能障碍综合征(MODS)确诊率及预后;并以入院1h及术后24、48、96和144h相关数据进行SIRS评分。结果600例患者中524例诊断为SIRS(占87.33%),其中A组73.37%(135/184例),B组91.48%(279/305例),C组99.10%(110/111例);SIRS分值A组各时间点均显著低于B组和C组(P均<0.01),B组又低于C组(P均<0.01);且A组术后96h基本正常,而B组术后144h才接近正常。ALI确诊率A组为5.98%(11/184例),发生ARDS1例,MODS1例,无死亡;B组为10.49%(32/305例),发生ARDS7例,MODS3例,死亡3例;C组则为20.72%(23/111例),发展为ARDS8例,MODS5例,死亡5例。结论创伤性休克院前救治与术后ALI密切相关,院前综合治疗有助于降低术后ALI/ARDS的发生率。Objective To investigate and analyze the correlation and clinical significance of prehospital treatment for traumatic shock and postoperative acute lung injury （ALI）/acute respiratory distress syndrome （ARDS）. Methods Six hundred cases in the last 10 years were enrolled for double-blind randomized control study. They were divided into 3 groups. Group A consisted of 184 cases who had received combined treatment, group B consisted of 305 cases who had received fluid replacement only and group C consisted of 111 cases with no treatment. The incidence of systemic inflammatory response syndrome （SIRS）, ALI and ARDS of each group were analyzed and compared. SIRS was graded at 1 （TO） after admission, 24 （T1）, 48 （T2）, 96 （T3） and 144 hours （T4） after operation. Results In 524 cases diagnosis of SIRS was made among 600 patients （87.33%）. Among them 73.37% （135/184 cases） were in group A, 91.48% （279/305 cases） belonged to group B and 99.10% （110/111 cases） in group C. The scores of SIRS were notably lower in group A than B and C at each time point （all P〈0.01）, and they were lower in group B than those in group C （all P〈0. 01）, they recovered at T3 after operation in group A while in group B patients recovered at 144 hours after operation. Eleven patients among 184 （5. 98%） were diagnosed to have ALI including 1 case progressed to ARDS and 1 case to MODS and no one died, while in group B 32 cases in 305 （10.49%） had ALI with 7 cases progressed to ARDS and 3 cases to MODS while 3 deaths and in group C 23 among 111 （20.72%） had ALI, and 8 patients progressed to ARDS, 5 cases to MODS and 5 deaths. Conclusion Prehospital treatment is closely related with postoperative ALI, and combined treatment is beneficial in reducing the incidence of postoperative ALI/ARDS.

关 键 词：休克 创伤性 院前救治 肺损伤 急性 全身炎症反应综合征 

分 类 号：R641[医药卫生—外科学]