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目的 对 2 1例急性呼吸窘迫综合征 (ARDS)的原发病、血气、治疗及预后进行分析 ,提高对ARDS认识 ,以期得到早期诊断和处理 ,降低病死率。方法 对 2 1例ARDS者进行血气监测、胸片等检查 ,13例给予呼吸末正压通气 (PEEP) ,6例行高频通气 ,2例鼻导管高浓度给氧纠正缺氧 ,常规给予地塞米松、速尿及人体白蛋白 ,控制入水量等综合治疗措施。结果 发现原发病最常见为感染 ( 4 7.6% ) ,其次为烧伤、创伤(各占 14.3% )。氧分压 (PaO2 )在 2 1～ 30mmHg、31～ 4 0mmHg、4 1～ 60mmHg时病死率分别为 10 0 %、4 0 %、0 % ;随病情进展 ,PaO2 越低 ,阴离子间隙 (AG)越高 ,预后越差 ;呼吸指数 (PaO2 /FiO2 )≤ 2 0 0mmHg和 >2 0 0mmHg者 ,病死率分别为 85.7% ( 6/7)、35.7% ( 5/14)。结论 严重感染最易发生ARDS ,ARDS病死率随病程进展及PaO2 越低而增高 ,PaO2 /FiO2 和AG可作为评估预后的有效指标 ,PEEP为抢救ARDS最有效措施
Objective To analyze the primary disease, blood gas, treatment and prognosis of 21 cases of acute respiratory distress syndrome (ARDS) and to improve the understanding of ARDS in order to get early diagnosis and treatment and reduce the mortality. Methods Blood gas monitoring, chest radiography and other examinations were performed in 21 ARDS patients. 13 cases were given positive end - expiratory pressure ventilation (PEEP), 6 cases were treated with high - frequency ventilation, and 2 cases of high concentration of nasal cannula were given oxygen to correct hypoxia. Dexamethasone, furosemide and human albumin, control the amount of water and other comprehensive treatment measures. The results showed that the most common primary infection was infection (4 7.6%), followed by burns and trauma (14.3% each). The partial pressure of oxygen (PaO2) was 10 0%, 40%, 0% respectively at 2 1 ~ 30mmHg, 31 ~ 40mmHg and 4 1 ~ 60mmHg. With the progress of the disease, the PaO2 was lower and the anion gap (AG) The higher the prognosis, the worse the prognosis was. The mortality rate was 85.7% (6/7) and 35.7% (5/14) respectively when PaO2 / FiO2 ≤ 2000 mmHg and> 2.0 mmHg. Conclusion Severe infection is most likely to occur ARDS, ARDS mortality with the progress of the disease and PaO2 lower and higher, PaO2 / FiO2 and AG can be used as a valid indicator to assess the prognosis, PEEP is the most effective measures to rescue ARDS