急性呼吸窘迫综合征的动态血气监测113例分析

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，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 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。

Analysis of arterial blood gas for 113 patients with acute respiratory stress syndrome

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(PaO 2/FiO 2) 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.