高海拔地区急性呼吸窘迫综合症的临床研究  

CLINICAL STUDY OF ARDS AT HIGH ALTITUDE

作　　者：杨永珠[1] 张建华[1] 李宗乾 

机构地区：[1]兰州医学院第二附属医院胸心外科,730030 [2]水电四局刘家峡职工医院外科

出　　处：《高原医学杂志》2001年第4期15-18,共4页Journal of High Altitude Medicine

摘　　要：目的 :探讨高海拔地区急性呼吸窘迫综合征 (ARDS)发病机理、临床特点、诊断标准及治疗措施 ;方法 :40例ARDS ,其中多器官功能障碍 1 4例 ,单纯用HFV治疗 2例 ,IPPV治疗 1 0例 ,交替通气方式HFV、IPPV或CMV治疗 1 6例 ,CMV或PSV治疗1 2例 ,血气分析 :PaO2 3 5mmHg～ 60mmHg( 4.66kPa～ 7.98kPa) ,平均 55mmHg( 7.3 2kPa) ,PaCO2 2 5mmHg～ 80mmHg( 3 .3 3kPa～ 1 0 .64kPa) ,平均 45mmHg( 5.99kPa) ,PaO2 /FiO2 40mmHg～ 2 0 0mmHg( 5.3 2kPa～ 2 6.60kPa) ,平均 1 80mmHg( 2 3 .94kPa) ,P(A -a)O2 (FiO2 =1 ) 1 50mmHg～ 2 50mmHg( 1 9.95kPa～ 3 3 .2 5kPa) ,平均 2 0 0mmHg( 2 6.60kPa) ,SaO2 40 %～ 90 % ,平均 85% ;结果 :全组治愈 3 3例 ,死亡 7例 ,死亡率 1 7.5% ;结论 :高海拔、低氧更易诱发急性肺损伤 (ALI)、ARDS ,并且起病急、进展快 ,早期合并心功能障碍者多 ,PaO2 /FiO2 ≤ 2 50mmHg( 3 3 .2 5kPa) (ALI) ,≤ 1 80mmHg( 2 3 .94kPa) (ARDS)为本地区临界值 ,及早应用机械通气可提高治愈率 ,中医中药可防治ARDS。Objective: To study the pathogenesis,clinical feature,diagnostis criteria and theraputic effect of patients with ARDS at high altitude.Methods: In this study,40 patients with ARDS,including 14 MODS patients were treated by different metheds;2 with HFV,10 with IPPV,16 with alternant using of HFV,IPPV or CMV ,12 with CMV or PSV. Blood gas analysis results:PaO 233mmHg～60mmHg(4.66kPa～ 7.98kPa ),mean 55mmHg (7.31kPa) , PaCO 2 25mmHg～80mmHg( 3.33kPa ～ 10.64kPa ),mean 45mmHg( 5.99kPa ),PaO 2/FiO 2 40mmHg～200mmHg (15.32kPa～26.6kPa),mean 180mmHg ( 23.94kPa ),P(A-a)O 2 (FiO 2=1) 150mmHg～250 mmHg (19.95kPa～ 33.25kPa ) ,mean 200mmHg(26.6kPa), SaO 224%～90%, mean 85%. Results:33 pationts were recovery and 7 pationts died at last .the mortality rate was 17.5%; Conclusions: Both high altitude and low oxgen content in the air are the inducements of ALI and ARDS ;Acute flaring up ,bad evolution and early heart failure are its three main characterstics; The boundary line of PaO 2/FiO 2 is 250mmHg (33.25kPa)for ALI,180mmHg(23.94kPa) for ARDS, respectively;Early useing of mechanical ventilation may improve recovery and traditional Chinese medicine is useful for ARDS patients.

关 键 词：急性肺损伤 急性呼吸窘迫综合症 诊断标准 高原 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统] R594.3[医药卫生—内科学]