成人呼吸窘迫综合征(ARDS)的诊治进展

<正> 成人呼吸窘迫综合征(Adult Respiratory DistressSyndome;ARDS)是由多种病因导致的表现为呼吸困难、进行性低氧血症、肺顺应性降低及一定的病理为特点的一种急性进行性呼吸衰竭,不同于心源性肺水肿所引起的呼吸困难,常用的吸氧疗法难以纠正其低氧血症,病死率高,且发病率有增高趋势。 ARDS首先由Ashbaugh报导,但此前即已发现类似病例,常有误吸、严重创伤、感染、败血症、休克、输液输血过量,长期的呼吸机应用,骨折后脂肪栓塞综合征等病史,由于病情复杂、凶险,因此在ARDS命名之前曾有各种命名,常用的有成人透明透膜肺、充血性肺不张,脂肪栓塞综合征、湿肺、休克肺、灌注肺,呼吸机肺等,但自ARDS诊断标准提出后获得广泛的同意,但必须认识该病为一综合征而不是一个     

创伤性成人呼吸窘迫综合征的诊治体会

就１３４８例严重创伤患者所发生的３３例成人呼吸窘迫综合征（ＡＲＤＳ）的诊治情况，探讨了与ＡＲＤＳ发生相关的因素。资料显示创伤的类型、特别是胸部创伤与ＡＲＤＳ发生有明显的相关性。作者强调诊断上怀疑ＡＲＤＳ发生患者必须在ＩＣＵ严密监测。本组所应用的创伤性ＡＲＤＳ发生指数公式Ｉ＝ＰＦ－（Ｎ＋Ｔ＋Ｆ＋Ｍ＋Ｘ）对ＡＲＤＳ的早期确诊和提示病情发展趋势很有帮助；治疗上要掌握好抗休克与ＡＲＤＳ的关系，胸部外伤和全身的关系；要以提高氧输送和氧摄取为重点，具体要落实于提高氧饱和度和心排出量上。同时作者还介绍了呼吸机疗法对创伤性ＡＲＤＳ患者的应用。     

感染所致成人呼吸窘迫综合征

感染所致成人呼吸窘迫综合征龙宝光（南昌市第九医院，南昌３３０００２）ＡｄｕｌｔＲｅｓｐｉｒａｔｏｒｙＤｉｓｔｒｅｓＳｙｎｄｒｏｍｅＣａｕｓｅｄｂｙＩｎｆｅｃｔｉｏｎＬｏｎｇＢａｏｇｕａｎｇ（ＴｈｅＮｉｎｔｈＨｏｓｐｉｔａｌｏｆＮａｎｃｈａｎｇＣｉｔｙ...     

急性创伤性成人呼吸窘迫综合征治体会

我院自1994年1月至1999年1月共收治16例急性创伤性成人呼吸窘迫综合征(Ａｃｕｔｅｒｅｓｐｉｒａｔｏｒｙｄｉｓｔｒｅｓｓｓｙｎｄｒｏｍｅ,ＡＲＤＳ)病人,现报告如下。1　临床资料1.1　一般资料　16例病人均因多发性复合性创伤后发生ＡＲＤＳ,男10例,女6例,年龄7～61(平均32)岁。全部病例均符合1995年重修ＡＲＤＳ诊断标准,临床上均有迅速加剧的呼吸窘迫、发绀、难以纠正的缺氧、呼吸频率≥28次/分,ＰａＯ2/ＦｉＯ2≤200ｍｍＨｇ,ＰａＯ2≤50ｍｍＨｇ,ＰａＣＯ2<33.75ｍｍＨｇ或>44.85ｍｍＨｇ[1]。胸片2例无实变,6例有双肺浸润影,8例肺野…     

不同吸痰方式对急性呼吸窘迫综合征患者肺换气功能的影响

目的研究不同吸痰方式对急性呼吸窘迫综合征(ARDS)机械通气患者肺换气功能的影响,选择更安全和有效的气管内吸痰方式,减少吸痰对肺气体交换的影响,提高吸痰操作的安全性.方法在外科重症监护病房选取诊断ARDS并行机械通气治疗的患者,每例患者均使用开放式气管内吸痰(OS)和密闭式气管内吸痰(CS)两种方式进行吸痰,吸痰顺序随机选择,观察记录患者在不同吸痰方式下,吸痰前后各个时间段的血气分析值和脉搏血氧饱和度(SpO2)的变化.结果OS后患者动脉血氧分压、动脉血氧饱和度、SpO2比吸痰前显著降低(P＜0.05),OS加重了ARDS患者低氧血症;而CS前后上述指标比较差异无显著性意义(P＞0.05).结论CS对ARDS患者肺换气功能影响较小,ARDS患者行机械通气治疗时气管内吸痰选择CS方式更为安全和适宜.     

白血病并发成人呼吸窘迫综合征6例

白血病并发成人呼吸窘迫综合征６例锦州医学院附属医院（１２１００１）蔡久英沈阳医学院附属中心医院夏书月报道我院收治的６例白血病并发成人呼吸窘迫综合征如下。１临床资料１．１诊断标准：本组６例成人型呼吸窘迫综合征（ＡＲＤＳ）诊断标准符合文献［１］诊断标准。...     

急性创伤性成人呼吸窘迫综合征诊治体会

我院自1994年1月至1999年1月共收治16例急性创伤性成人呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)病人,现报告如下.     

关于急性呼吸窘迫综合征的诊断

通过对１７例急性感染患者资料分析，从急性呼吸窘迫综合征（ＡＲＤＳ）的发展过程探讨其诊断，特别是早期诊断。     

Computer-based evaluation of cardiopulmonary function for the optimization of ventilatory therapy in the adult respiratory distress syndrome

Summary A computer based evaluation system has been developed for the assessment of respiratory pressure flow dynamics, pulmonary gas exchange and ventilation perfusion interrelationships. This system is based on the acquisition of primary data on-line from intubated and ventilated patients consisting of airway pressures, ventilatory flows and mass spectrometric quantification of inspired and expired gas concentrations. The system has been applied to the study of patients with the adult respiratory distress syndrome (ARDS) following trauma and/or sepsis. The programs developed for evaluation of these data permit an interactive graphic capability to be used by the physician or the respiratory technician in a specific patient to determine the nature of the abnormalities in respiratory function. By use of this system for quantification of the extent and complications of the ARDS condition the specific ventilatory or cardiodynamic therapy can be tailored to meet the patient's physiologic needs. Techniques for optimization of conventional ventilator therapy are described and its application to the specific instances of combined high frequency ventilation or differential lung ventilation are presented. The clinical experience with this unit in a major trauma center suggests that quantitative analysis of an individual patients' respiratory dysfunction permits a precise, accurate and more effective approach to determining corrective therapy in ARDS.     

严重胸外伤并发成人呼吸窘迫综合征的早期预测、诊断与治疗(附18例报告)

目的探讨严重胸外伤并发成人呼吸窘迫综合征(ARDS)的早期临床预测、诊断及防治.方法对18例患者的血气及创伤性ARDS发生指数进行回顾分析,对呼吸机相关肺炎(VAP)进行病原菌及药敏分析.结果早期PaCO     

赤芍对油酸致成人呼吸窘迫综合征治疗作用的观察

以１６只健康杂种犬随机分成两组，组Ⅰ为对照组，油酸（ＯＡ）＋生理盐水；组Ⅱ为处理组，ＯＡ＋赤芍（ＲＰＲ）。中心静脉注入油酸，３０ｍｉｎ后静注赤芍注射液。结果：两组均在注ＯＡ３０ｍｉｎ后出现成人呼吸窘迫综合征（ＡＲＤＳ），６０ｍｉｎ后组Ⅱ动脉血氧分压（ＰａＯ＿２）、心脏指数（ＣＩ）及血液氧输送（ＤＯ＿２）较组Ⅰ显著升高，１２０ｍｉｎ后，组Ⅱ肺动脉平均压（ＰＡＭＰ）、肺循环阻力指数（ＰＶＲＩ）、肺分流率（Ｑｓ／Ｑｔ）及肺死腔率（Ｖ＿Ｄ／Ｖ＿Ｔ）显著低于组Ⅰ（Ｐ＜０．０５或＜０．０１）。两组肺毛细血管楔压（ＰＣＷＰ）、平均动脉压（ＭＡＰ）以及氧利用（ＶＯ＿２）差异无统计学意义。提示：ＲＰＲ能显著改善油酸所致ＡＲＤＳ的血流动力学、肺及血液的氧合功能。     

糖皮质激素在重症医学科急性呼吸窘迫综合征中的应用

目的评价糖皮质激素(glucocorticoids,GCs)在重症监护室(intensive care unit,ICU)治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的作用。方法回顾性分析本院入住ICU的ARDS患者的临床资料,并根据致病因素在肺损伤中的作用,将所入选患者分为肺内源性ARDS(primarily from pulmonary diseases,ARDSp)和肺外源性ARDS(primarily from extra-pulmonary diseases,ARDSexp);ARDSp患者62例,ARDSexp患者101例。根据GCs的使用量各分为3组,分析ARDSp及ARDSexp应用GCs和未应用GCs患者的病情改善和病死率。结果 ARDSp及ARDSexp患者各组急性生理与慢性健康评分(Acute Physiology and Chronic Health EvaluationⅡ,APACHE-Ⅱ)相当(P0.05)。GCs治疗30mg/d组与≥30mg/d组比较,病情改善时间和呼吸机治疗时间明显缩短(P0.01),病死率也略低(P0.05);GCs治疗30mg/d组与非GCs治疗组比较差异有统计学意义(P0.01);≥30mg/d组与非GCs治疗组比较差异无统计学意义(P0.05)。ARDS患者总体病死率23.3%(38/163),其中使用GCs治疗组病死率22.8%(34/149),未使用GCs治疗组病死率28.6%(4/14)(P0.05)。结论低剂量(30mg/d)、早期应用(24h内)、长期疗程(7d)的GCs,可及时遏制炎性介质的"瀑布样效应",在一定程度上缩短病程,降低病死率。     

Miliary tuberculosis presenting as adult respiratory distress syndrome

We report the history of a 27-year-old Caucasian girl who died of adult respiratory distress syndrome secondary to miliary tuberculosis (MTB), after treatment with antibiotics to which the organism was sensitive, and a long period of ventilation. This case emphasises the importance of considering MTB as the cause of respiratory failure when another aetiology is not apparent.     

斑点追踪成像技术评估呼吸窘迫综合征早产儿左室心肌功能的应用研究

目的 采用二维斑点追踪成像(2DSTI)技术评估患有新生儿呼吸窘迫综合征的(NRDS)早产儿左室心肌的功能并分析该技术的临床应用价值。方法 随机选取于我院出生的新生儿41名,分为NRDS早产儿组20例、非NRDS早产儿组10例、足月正常新生儿11例。采用2DSTI获取三组左室整体纵向峰值应变(GLPS)及各室壁应变测值,并收集常规左室心肌功能超声参数,包括左室射血分数(LVEF)、二尖瓣舒张早期及晚期血流速度(MV-E、MV-A)、二尖瓣环组织多普勒收缩期峰值速度(MV-S")、二尖瓣环收缩期位移(MAPSE)和左室Tei指数。结果 GLPS三组总差异及组间差异具有统计学意义(P＜0.05),与非NRDS早产儿与足月对照组相比,NRDS早产儿组GLPS均减低,差异具有统计学意义(P＜0.05);非NRDS早产儿组与足月对照组之间GLPS差异无统计学意义(P＞0.05)。与其它两组相比,NRDS早产儿组MV-S"减低、MAPSE减低,左室Tei指数增高(P＜0.05);各组LVEF、MV-E、MV-A差异均无统计学意义(P＞0.05)。结论 NRDS早产儿左室心肌功能较非NRDS早产儿及正常新生儿减低,GLPS、MV-S"、MAPSE及左室Tei指数能较LVEF更早期发现左室心肌受损的情况。     

Use of prostacyclin and ultrafiltration in adult respiratory distress syndrome

A primigravida with severe kyphoscoliosis developed cardio-respiratory failure in pregnancy. Cardiac arrest occurred 10 days after Caesarean section; gastric acid was aspirated then and was followed by the development of adult respiratory distress syndrome. Initial recovery, with clearing of peripheral oedema, was followed by a recurrence of respiratory distress associated with infection. Profound hypoxaemia and oliguria unresponsive to diuretics were relieved by the infusion of prostacyclin combined with fluid removal by ultrafiltration. This treatment may be of value in the management of respiratory distress syndrome when pulmonary oedema is the dominant feature.     

Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors

PURPOSE: Describe initial development and validation of a test battery composed of established instruments designed to detect, via telephone interview, cognitive abnormalities in survivors of acute respiratory distress syndrome. METHODS: Two cross-sectional studies were performed, including the following phases: (1) initial battery construction, (2) feasibility, (3) item reduction, (4) convergent and divergent validity, and (5) telephone administration compared with in-face interviews in a separate population. RESULTS: There was a broad range of cognitive function detected in the derivation population, and all subjects completed the interview. There was convergence of cognitive impairment with moderate/severe anxiety (P = .008), the Sickness Impact Profile Psychosocial Summary Score (mean difference, 15.3; 95% CI, 7.74-22.9; P = .0001), and the mental health domains of the Short Form 36. Subjects with cognitive impairment had no detectable difference in the physical function domains of the Short Form 36. When administered to the validation population, telephone tests of memory, attention, reasoning, and executive functions had good intraclass correlation with the in-face interviews (P < .01). CONCLUSIONS: Detection of cognitive abnormalities in acute respiratory distress syndrome survivors using a telephone-administered test battery derived from standard cognitive tests is feasible and has evidence of construct validity. This battery may be useful as a research tool when in-face interviews are not feasible.