胸腔闭式引流致复张性肺水肿的防治  

Clinical features and causative factors of reexpansion pulmonary edema caused by thoracic close drainage in traumatic patients： analysis of 16 cases

作　　者：杨帆[1] 白祥军[1] 刘开俊[1] 李波[1] 王宁[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,湖北430030

出　　处：《中国急救复苏与灾害医学杂志》2009年第5期288-290,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的研究创伤患者胸腔闭式引流致复张性肺水肿（RPE）的临床特点和诱发因素。方法分析147例实施胸腔闭式引流的创伤患者（16例伴RPE组，131例不伴非肺水肿）的临床资料。结果RPE组锐器伤患者占43．75％，〉60岁者占37．50％，人均既往相关病史数目为0．31个，肺压缩程度〉60％的患者比率为31．25％，手术首次的液体、气体引流量平均为655．35ml，术中和术后1h内输注总液体量为2246．72ml，病死率为18．75％，均显著高于非肺水肿组同类数值（均P〈0．05）。RPE组死亡患者的平均年龄为62岁，平均总液体人量2631．67ml，双侧肺损伤患者为100％，肺压缩时间平均为14h，肺压缩程度平均为76．67％，PaCO2平均为52mmH2O，急性肺损伤（ALI），成人呼吸窘迫综合征（ARDS）患者占100％，均显著高于生存组同类数值（均P〈0．05）。结论RPE主要发生在老年、锐器伤、肺压缩程度重的患者，且年龄越大，输液量越多，引流越快，肺压缩时间越长，肺压缩程度越重，并发RPE越多，越容易导致死亡。Objective To investigate the clinical features and causative factors of reexpansion pulmonary edema （RPE） caused by thoracic close drainage in traumatic patients. Methods The clinical data of 147 traumatic patients undergoing thoracic close drainage, 16 with RPE and 131 without RPE, were analyzed. Results Of the 16 RPE patients, 43.75% were with sharp instrument injury, 37.50% were aged 〉60, and 31.25% were with severe lung compression （〉60%）, the average number of related anamneses was 0.31, the average amount of drainage of fluid and gas during operation was 655.35 ml, the total amount of fluid intake during and lh after operation was 2246.72 ml, and mortality was 18.75%; all these parameters of the RPE patients were significantly higher than those of the non-RPE group （all P〈 0.05）. Three of the 16 RPE patients, average age of 62 years, died, all with bilateral lung injury and acute lung injury/aduh respiratory distress syndrome, and with the total fluid intake of 2631.67 ml, lung compression time of 14 h, lung compression degree of 76.67%, and PaCO2 of 52 mmH2O, and all these parameters were significantly higher than those of the surviving RPE patients （all P〈 0.05）. Conclusion RPE mostly occurs in the patients with higher age, sharp instrument injury, and severe lung compression. The higher the age, the more the fluid intake, the quicker the drainage, the longer the lung compression time, and the higher the lung compression degree, the higher the complication rate and mortality.

关 键 词：创伤 复张性肺水肿 

分 类 号：R641[医药卫生—外科学]