CAJ | 학술논문

目的　探讨动态监测血气对急性呼吸窘迫综合征(ARDS)的早期诊断、治疗和预后判断的临床意义。方法　回顾分析了我院16年间危重病患者并发ARDS 113例655例次动脉血气分析、酸碱紊乱类型和氧合指数(PaO2/FiO2)等资料。结果　(1)酸碱失衡类型：113例中单纯酸碱紊乱44例，含呼碱20例，呼酸11例，代酸10例，代碱3例；二重酸碱紊乱53例，含呼碱并代酸12例，呼碱并代碱14例，呼酸并代酸21例，呼酸并代碱6例；三重酸碱失衡(TABD)16例，含呼碱型TABD11例，呼酸型TABD5例。治愈各组以单纯呼碱(17例)和呼碱并代碱(12例)等类型多见；死亡组以呼酸并代酸(19例)、TABD(14例)、呼酸(9例)等类型多见；(2)氧合指数：113例患者的氧合指数均<26.7kPa；(3)113例ARDS治愈52例(46.0%)，死亡61例(54.0%)。结论　通过对113例危重患者并发ARDS的血气分析，动态监测血气和计算氧合指数，对ARDS的早期诊断和治疗具有重要的临床价值，而正确分析、判断酸碱失衡类型是正确治疗和提高治愈率的重要环节。
목적　탐토동태감측혈기대급성호흡군박종합정(ARDS)적조기진단、치료화예후판단적림상의의。방법　회고분석료아원16년간위중병환자병발ARDS 113례655례차동맥혈기분석、산감문란류형화양합지수(PaO2/FiO2)등자료。결과　(1)산감실형류형：113례중단순산감문란44례，함호감20례，호산11례，대산10례，대감3례；이중산감문란53례，함호감병대산12례，호감병대감14례，호산병대산21례，호산병대감6례；삼중산감실형(TABD)16례，함호감형TABD11례，호산형TABD5례。치유각조이단순호감(17례)화호감병대감(12례)등류형다견；사망조이호산병대산(19례)、TABD(14례)、호산(9례)등류형다견；(2)양합지수：113례환자적양합지수균<26.7kPa；(3)113례ARDS치유52례(46.0%)，사망61례(54.0%)。결론　통과대113례위중환자병발ARDS적혈기분석，동태감측혈기화계산양합지수，대ARDS적조기진단화치료구유중요적림상개치，이정학분석、판단산감실형류형시정학치료화제고치유솔적중요배절。
Objective　To explore the significance of dynamic determination of arterial blood gas for early diagnosis, treatment and prognosis of patients with acute respiratory stress syndrome(ARDS). Methods　The results of 655 times arterial blood gas assayed in 113 patients with ARDS were analysed retrospectively.Results　(1)Types of acid-basic disturbance:The simple acid-base disturbances were 44 cases,in which respiratory alkalosis were 20 cases, respiratory acidosis 11 cases, metabolic acidosis 10 cases, metabolic alkalosis 3 cases. Complex acid-base disturbances were 53 cases,in which respiratory alkalosis with metabolic acidosis were12 cases, respiratory alkalosis with metabolic alkalosis 14 cases, respiratory acidosis with metabolic acidosis 21 cases, respiratory alkalosis with metabolic alkalosis 6 cases. Triple acid-base disturbances (TABD) were 16 cases, in which the type of respiratory alkalosis were 11 cases, the type of respiratory acidosis 5 cases. the types of acid-base disturbances in cured patients mainly were respiratory alkalosis (17 cases) and respiratory alkalosis with metabolic alkalosis (12 cases). The types of acid-base disturbances in dead patients were mainly respiratory acidosis with metabolic acidosis (19 cases),TABD (14 cases) and respiratory acidosis (9 cases).(2)The oxygenation indexes(PaO2/FiO2) of all 113 patients were less than 26.7kPa.(3)The cured rate in 113cases was 53/113(46.0%)and the mortality was 61/113(54.0%).Conclusion　Dynamic determination of arterial blood gas and calculation of index of oxygenation were of important clinical value in diagnosis and treatment of ARDS.