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目的 研究机械通气治疗恶性肿瘤放疗导致的ARDS患者临床疗效、并发症及预后 ,进一步提高该类患者的生存率。方法 4 7例患者中 ,恶性肿瘤放疗导致ARDS患者 15例 ,其他原因导致ARDS 32例 ,比较放疗组和非放疗组机械通气前后氧合情况、机械通气并发症和住院期间死亡率。结果 两组患者机械通气后 12、4 8h时PaO2 、氧合指数均比治疗前显著改善 (P <0 .0 1) ,但放疗组在机械通气后 72h时PaO2 、氧合指数与治疗前无明显差异 (P >0 .0 5 ) ;与放疗组相比 ,非放疗组机械通气后 12、4 8、72h时PaO2 、氧合指数改善更为显著 (P <0 .0 1)。放疗组气胸、呼吸机相关性肺炎 (VAP)、多器官功能障碍综合征 (MODS)发生率均显著高于非放疗组 (P <0 .0 1)。放疗组住院期间死亡率显著高于非放疗组 (P <0 .0 1)。结论 恶性肿瘤放疗导致的ARDS患者预后极差 ,机械通气只能短暂应用于该类患者急救 ,并不能改善预后。对于肿瘤放疗患者重点在于预防ARDS的发生
Objective To study the clinical efficacy, complications and prognosis of mechanical ventilation in the treatment of patients with ARDS caused by malignant tumor radiotherapy, and to further improve the survival rate of patients with ARDS. Methods In the seventeen patients, 15 cases of ARDS were caused by radiotherapy of malignant tumors and 32 cases of ARDS due to other causes. The oxygenation before and after mechanical ventilation was compared between radiotherapy group and non-radiotherapy group, complications of mechanical ventilation and in-hospital mortality. Results PaO2 and oxygenation index of both groups were significantly improved at 12 h and 48 h after mechanical ventilation (P <0.01), but the PaO2 and oxygenation index of radiotherapy group at 72 h after mechanical ventilation were significantly lower than those before treatment (P 0. 05). Compared with the radiotherapy group, PaO2 and oxygenation index improved more significantly at 12, 48, 72 hours after mechanical ventilation in non-radiotherapy group (P <0.01). The incidence of pneumothorax, ventilator-associated pneumonia (VAP) and multiple organ dysfunction syndrome (MODS) in radiotherapy group were significantly higher than those in non-radiotherapy group (P <0.01). Mortality during radiotherapy hospitalization was significantly higher than non-radiotherapy (P <0.01). Conclusion The prognosis of patients with ARDS caused by radiotherapy of malignant tumors is very poor. Mechanical ventilation can only be briefly applied to the first aid of such patients, and can not improve the prognosis. For cancer radiotherapy patients focus on preventing the occurrence of ARDS