中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
2期
128-131
,共4页
庄育田%王延玲%白士先%孙继玲%马云
莊育田%王延玲%白士先%孫繼玲%馬雲
장육전%왕연령%백사선%손계령%마운
胸外伤%呼吸窘迫综合征%机械通气
胸外傷%呼吸窘迫綜閤徵%機械通氣
흉외상%호흡군박종합정%궤계통기
Chest injury%Acute respiratory distress syndrome%Mechanical ventilation
目的 探讨早期有创机械通气治疗胸外伤致呼吸窘迫综合征(ARDS)的临床意义.方法 回顾性分析93例胸外伤致ARDS有创机械通气患者临床资料,根据有创机械通气情况分为延迟通气组(45例)和及时通气组(48例).比较两组患者有创机械通气治疗前后血气分析、氧合指数、心率、乳酸、呼吸肌动用评分及两组患者机械通气治疗时间、并发症发生率、病死率、住院时间的差异.结果 延迟组与及时组患者在机械通气治疗后各项指标分别为动脉血氧分压(PaO2)(63.2±12.3)、(74.2±12.1) mmHg,动脉血二氧化碳分压(PaCO2)(39.4±8.7)、(38.9±7.6) mmHg,氧合指数(PaO2/FiO2)196.2±17.8、、231.4±18.2、,呼吸频率(27.4±3.7)、(21.1±3.4)次/min,心率(117.2±26.8)、(96.0±25.1)次/min,辅助呼吸肌动用评分(2.69±0.15)、(1.67±0.10)分,乳酸(4.23±1.70)、(2.12±0.80)mmol/L,除PaCO2外,其余各项指标差异均具有统计学意义(t值分别为4.346、9.420、3.949、5.436、38.809、7.736,P均＜0.05)；延迟组与及时组机械通气治疗时间分别为(10.21±1.50)、(6.47±1.20)d,住院时间(21.53±1.90)、(16.32±2.10)d,及时组均低于延迟组,差异均有统计学意义(t值分别为 12.518、13.318,P均＜0.01)；延迟组与及时组病死率[26.7％(12/45)、14.6％(7/48)]、呼吸机相关性肺炎[46.7％ (21/45)、22.9％ (11/48)]、急性胃黏膜病变[33.3％(15/45)、12.5％ (6/48)]、多器官功能衰竭[40.0％ (18/45)、16.7％(8/48)]、气胸发生率[11.1％(5/45)、8.3％ (4/48)],除气胸外,及时组均低于延迟组,差异均有统计学意义(X2值分别为3.86、5.81、4.49、5.70,P均＜0.05).结论 有创机械通气是治疗胸部外伤所致ARDS的有效方法,早期有创机械通气可以有效降低患者的病死率和并发症发生率,缩短机械通气时间和住院时间.
目的 探討早期有創機械通氣治療胸外傷緻呼吸窘迫綜閤徵(ARDS)的臨床意義.方法 迴顧性分析93例胸外傷緻ARDS有創機械通氣患者臨床資料,根據有創機械通氣情況分為延遲通氣組(45例)和及時通氣組(48例).比較兩組患者有創機械通氣治療前後血氣分析、氧閤指數、心率、乳痠、呼吸肌動用評分及兩組患者機械通氣治療時間、併髮癥髮生率、病死率、住院時間的差異.結果 延遲組與及時組患者在機械通氣治療後各項指標分彆為動脈血氧分壓(PaO2)(63.2±12.3)、(74.2±12.1) mmHg,動脈血二氧化碳分壓(PaCO2)(39.4±8.7)、(38.9±7.6) mmHg,氧閤指數(PaO2/FiO2)196.2±17.8、、231.4±18.2、,呼吸頻率(27.4±3.7)、(21.1±3.4)次/min,心率(117.2±26.8)、(96.0±25.1)次/min,輔助呼吸肌動用評分(2.69±0.15)、(1.67±0.10)分,乳痠(4.23±1.70)、(2.12±0.80)mmol/L,除PaCO2外,其餘各項指標差異均具有統計學意義(t值分彆為4.346、9.420、3.949、5.436、38.809、7.736,P均＜0.05)；延遲組與及時組機械通氣治療時間分彆為(10.21±1.50)、(6.47±1.20)d,住院時間(21.53±1.90)、(16.32±2.10)d,及時組均低于延遲組,差異均有統計學意義(t值分彆為 12.518、13.318,P均＜0.01)；延遲組與及時組病死率[26.7％(12/45)、14.6％(7/48)]、呼吸機相關性肺炎[46.7％ (21/45)、22.9％ (11/48)]、急性胃黏膜病變[33.3％(15/45)、12.5％ (6/48)]、多器官功能衰竭[40.0％ (18/45)、16.7％(8/48)]、氣胸髮生率[11.1％(5/45)、8.3％ (4/48)],除氣胸外,及時組均低于延遲組,差異均有統計學意義(X2值分彆為3.86、5.81、4.49、5.70,P均＜0.05).結論 有創機械通氣是治療胸部外傷所緻ARDS的有效方法,早期有創機械通氣可以有效降低患者的病死率和併髮癥髮生率,縮短機械通氣時間和住院時間.
목적 탐토조기유창궤계통기치료흉외상치호흡군박종합정(ARDS)적림상의의.방법 회고성분석93례흉외상치ARDS유창궤계통기환자림상자료,근거유창궤계통기정황분위연지통기조(45례)화급시통기조(48례).비교량조환자유창궤계통기치료전후혈기분석、양합지수、심솔、유산、호흡기동용평분급량조환자궤계통기치료시간、병발증발생솔、병사솔、주원시간적차이.결과 연지조여급시조환자재궤계통기치료후각항지표분별위동맥혈양분압(PaO2)(63.2±12.3)、(74.2±12.1) mmHg,동맥혈이양화탄분압(PaCO2)(39.4±8.7)、(38.9±7.6) mmHg,양합지수(PaO2/FiO2)196.2±17.8、、231.4±18.2、,호흡빈솔(27.4±3.7)、(21.1±3.4)차/min,심솔(117.2±26.8)、(96.0±25.1)차/min,보조호흡기동용평분(2.69±0.15)、(1.67±0.10)분,유산(4.23±1.70)、(2.12±0.80)mmol/L,제PaCO2외,기여각항지표차이균구유통계학의의(t치분별위4.346、9.420、3.949、5.436、38.809、7.736,P균＜0.05)；연지조여급시조궤계통기치료시간분별위(10.21±1.50)、(6.47±1.20)d,주원시간(21.53±1.90)、(16.32±2.10)d,급시조균저우연지조,차이균유통계학의의(t치분별위 12.518、13.318,P균＜0.01)；연지조여급시조병사솔[26.7％(12/45)、14.6％(7/48)]、호흡궤상관성폐염[46.7％ (21/45)、22.9％ (11/48)]、급성위점막병변[33.3％(15/45)、12.5％ (6/48)]、다기관공능쇠갈[40.0％ (18/45)、16.7％(8/48)]、기흉발생솔[11.1％(5/45)、8.3％ (4/48)],제기흉외,급시조균저우연지조,차이균유통계학의의(X2치분별위3.86、5.81、4.49、5.70,P균＜0.05).결론 유창궤계통기시치료흉부외상소치ARDS적유효방법,조기유창궤계통기가이유효강저환자적병사솔화병발증발생솔,축단궤계통기시간화주원시간.
Objective To explore the clinical significance of early invasive mechanical ventilation for acute respiratory distress syndrome (ARDS) caused by thoracic trauma.Methods We retrospectively analyzed the clinical data of 93 patients of invasive mechanical ventilation in those with ARDS caused by thoracic trauma,and divided them into delayed invasive mechanical ventilation group (n =45) and timely invasive ventilation group (n =48) by the time of invasive mechanical ventilation.We compared the blood gas analysis,oxygen index,heart rate,lactic acid,muscle use score of the two groups before and after invasive mechanical ventilation and the differences of mechanical ventilation time,incidence of complications,mortality and length of hospital stay between the two groups.Results Each index of the delayed invasive mechanical ventilation group and the timely invasive ventilation group was calculated:PaO2 (63.2 ± 12.3,74.2 ± 12.1)mm Hg,PaCO2 (39.4 ±8.7,38.9 +7.6) mm Hg,PaO2/FiO2 (196.2 ± 17.8,231.4 ± 18.2),respiratory rate (27.4 ±3.7,21.1 ± 3.4) beats/min,heart rate (117.2 ± 26.8,96.0 ± 25.1) beats/min,accessory muscle use score (2.69 ± 0.15,1.67 ± 0.10),lactic acid (4.23 ± 1.70,2.12 ± 0.80) mmol/L Except for PaCO2,the differences of each index were statistically significant (t values were respectively 4.346,9.420,3.949,5.436,38.809,7.736; P ＜ 0.05).The duration of mechanical ventilation treatment (10.21 ± 1.50,6.47 ± 1.20) d and the length of hospital stay (21.53 ± 1.90,16.32 ±2.10) d of the delayed group and the timely group were significantly different (t values were respectively 12.518,13.318; P ＜ 0.01).The timely group had significantly lower mortality rate (26.7％ (12/45),14.6％ (7/48)),VAP (46.7％ (21/45),22.9％(11/48)),acute gastric mucosal lesions (33.3％ (15/45),12.5％ (6/48)),MODS (40.0％ (18/45),16.7％ (8/48)) than the delayed group (x2 values were respectively 3.86,5.81,4.49,5.70; P ＜ 0.05).There is no significant difference on the incidence of pneumothorax between the two groups (11.1％ (5/45),8.3％ (4/48)).Conclusion Invasive mechanical ventilation is an effective treatment of ARDS caused by chest trauma.Early invasive mechanical ventilation can reduce the mortality rate and shorten the duration of mechanical ventilation and hospital stay of the patients with ARDS after severe thoracic trauma.
