机械通气在肾移植术后间质性肺炎合并急性呼吸窘迫综合征抢救中的价值探讨  

Evaluation of mechanical ventilation for patients with acute respiratory distress syndrome as a result of interstitial pneumonia after renal transplantation

作　　者：宋志芳[1] 俞康龙[2] 单红卫[2] 马钧[2] 

机构地区：[1]上海第二医科大学附属新华医院内科ICU,上海200092 [2]第二军医大学附属长征医院急救科,上海200003

出　　处：《中国危重病急救医学》2003年第6期358-361,共4页Chinese Critical Care Medicine

基　　金：上海市卫生局科技发展基金资助项目 ( 0 0 40 9)

摘　　要：目的 :探讨机械通气在抢救肾移植术后间质性肺炎合并急性呼吸窘迫综合征 (ARDS)中的价值。方法 :收集 16例综合 ICU(GICU)内肾移植术后因间质性肺炎合并 ARDS患者的临床资料 ,分析与比较机械通气后缺氧改善情况等 ,了解和判断机械通气治疗的价值及影响抢救成功率的主要环节。结果 :16例患者中 ,15例应用了机械通气与不同水平的呼气末正压〔 PEEP,4～ 15 cm H2 O(1cm H2 O=0 .0 98k Pa)〕治疗 ,1例未用机械通气治疗 ;机械通气治疗〔1～ 87d,平均 (15 .4± 2 1.1) d〕与生存时间〔1～ 194 5 d,平均 (15 4 .4± 4 97.1) d〕不等 ;仅 1例痊愈 (6 .7% ) ,14例死亡 (93.3% )。死亡原因分析提示 ,在应用机械通气治疗的患者中 ,病程短(≤ 3d)的患者 (3例 ) ,导致死亡的直接因素为非呼吸因素 (循环和中枢神经 ) ;未应用机械通气治疗的患者(1例 )导致死亡的直接原因为缺氧。分析 1例抢救成功病例的主要经验在于及时应用机械通气并纠正了缺氧 ,为原发病的治疗赢得了时间。结论 :机械通气抢救肾移植术后间质性肺炎合并 ARDS的主要价值在于纠正缺氧 ,病原学诊断与治疗方面的困难可能是抢救成功率低的主要原因。Objective: To evaluate the clinical value of mechanical ventilation for patients with acute respiratory distress syndrome(ARDS) as a result of interstitial pneumonia after renal transplantation in the intensive care unit(ICU). Methods: All the clinical data(totally 16 cases) were collected, including the improvement of hypoxemia before and after mechanical ventilation. Results: Different levels of positive end expiratory pressure(PEEP) 415 cm H 2O(1 cm H 2O=0 098 kPa)were applied in the patients in whom mechanical ventilation was in stituted. The time for different mechanical ventilation was different 〔187 days, (15 4±21 1)days〕 and duration of survival was different 〔11 945 days, (154 4±497 1)days〕. Only one of them was survived(6 7%), and the others died(93 3%). The causes of death were analyzed. Among the patients who received the mechanical ventilation, 3 patients were alive less than 3 days and their direct cause of death was not respiratory(circulation and central). Only one of them did not receive artifical ventilation and the cause of death was hypoxemia.The successful experience for one survivor among the patients who received the ventilator was that hypoxemia was improved by the mechanical ventilation, winning the time for the treatment of the original disease. Conclusion: The major value of mechanical ventilation was to correct the hypoxemia in order to win the time to cure the interstitial pneumonia and ARDS. The survival rate was still low for such a group of patients because the pathogenesis was not identified, and therefor the disease could not be controlled, even the mechanical ventilation is instituted in time.

关 键 词：机械通气 肾移植术后 肺炎 间质性 急性呼吸窘迫综合征 呼气末正压通气 

分 类 号：R699.2[医药卫生—泌尿科学]