围术期大量输血患者并发急性呼吸窘迫综合征相关因素分析  

Study on correlated factors of acute respiratory disorders syndrome in patients with parioperative massive transfusion.

作　　者：张爱民[1] 陈永学[2] 史计月[1] 耿岩[2] 张洪林[3] 李金柱[2] 侯宝君[1] 

机构地区：[1]河北工程大学附属医院麻醉科,河北省邯郸市056029 [2]邯郸市中心医院 [3]河北工程大学附属医院骨科,河北省邯郸市056029

出　　处：《中国综合临床》2006年第11期1009-1012,共4页Clinical Medicine of China

基　　金：河北省科学技术攻关课题(92216127D)

摘　　要：目的分析围手术期大量输血患者术后并发急性呼吸窘迫综合征(ARDS)的相关因素,探讨大量输血对创伤、手术后并发ARDS的影响。方法符合围手术期输血量≥60ml/kg的创伤、手术患者682例,其中术后并发急性肺损伤(ALI)/ARDS126例(A组),未并发ALI/ARDS556例(B组);对比分析2组的创伤、手术患者输血时机与质量、诊断与并发症、初诊或围手术期治疗相关措施等指标。结果A组患者创伤早期输血量显著大于B组(P<0.05),且库存全血量极显著高于B组(P<0.05);同时,A组患者以严重创伤为主,胸部创伤、颅脑创伤并呕吐误吸、休克持续时间、初诊呼吸管理不到位和早期合并感染等相关因素均显著高于B组(P<0.01)。结论围手术期大量输血并非术后ALI/ARDS的直接诱因,病情重与早期治疗措施不到位是其主要因素。Objective To study the correlated factors of complication with acute respiratory disorders syndrome （ARDS） in patients receiving massive transfusion during and surrounding operation timeand to discuss the effect of massive transfusion on trauma and the occurrence of ARDS after surgery. Methods 682 cases with trauma or operation whose blood transfusion amount was over 60 ml/kg during and surrounding operation time were studied. There were 126 cases complicated with acute lung injury（ALI）/ARDS after operation （group A） and the other 556 cases were without ALI/ARDS （ group B ）. Factors as transfusion time and quality, primary diagnosis, complications and treatment were analyzed. Results The blood transfusion amount were notably higher in group A （ P 〈 0.05 ） and the ratio of the amount of the amount of storage whole blood were also notably higher in group A than those in group B（P 〈 0.05 ）. The serious trauma were the main character of group A. Correlative factors as thoracic injuries ,craniocerebral injury complicated with aspiration, duration of shock, insufficient respiration control and early concurrent infection were notably higher in group A （ P 〈 0.01） than those in group B. Conclusion Parioperativessive transfusion is not the direct factor of complication of ALI/ARDS after operation. The worse state of the illness and insufficient treatment in early stage are the main factors.

关 键 词：创伤 输血 急性呼吸窘迫综合征 

分 类 号：R457[医药卫生—治疗学]