30例肺癌术后并发急性呼吸窘迫综合征的分析报告

胸科手术后患者出现急性呼吸窘迫综合征，是由多种因素引起的急性呼吸衰竭症候群，同时也是胸科手术后的一种严重并发症，在临床上存在一定的发生率，即使在临床急救设施和技术日趋完善的今天，病死率仍高达50％左右，在胸外科领域，尤其是在治疗肺癌的胸外科领域越来越受到广泛的重视。现将我院、自1991年1月～2006年1月的15年间胸科手术后并发急性呼吸窘迫综合征30例患者的临床资料分析总结如下。     

压力控制PEEP小潮气量通气模式治疗28例创伤性ARDS

目的 探讨压力控制呼气末正压呼吸小潮气量通气模式治疗创伤性急性呼吸窘迫综合征的疗效。方法 应用多功能呼吸机压力控制呼气末正压呼吸小潮气量通气模式治疗28例创伤性急性呼吸窘迫综合征患者。结果 28例患者抢救成功23例，成功率82．1％，无相关治疗性肺损伤。结论 压力控制急性呼吸窘怕综合征小潮气量通气模式治疗创伤性急性呼吸窘迫综合征是安全有效并值得推广的一种治疗方法。     

重症肺炎疑似急性呼吸窘迫综合症临床诊断及治疗观察

目的 探讨重症肺炎疑似急性呼吸窘迫综合征临床正确诊断及治疗措施.方法 对63例重症肺炎合并急性呼吸窘迫综合征患者临床资料进行回顾性分析,内容包括诊断方法、治疗方法、临床疗效等,分析方法为查阅本次就诊相关病历资料、询问当事接诊医护人员、咨询患者本人及家属等,将所得数据经统计学分析后得出结论.结果 63例重症肺炎合并急性呼吸窘迫综合征患者经临床对症治疗后有效率90.48％(57例),与死亡率(9.52％,6例)对比结果具有统计学意义(P＜0.05);治疗后PaCO2、PaO2 、pH均较治疗前显著改善(P＜0.05).结论 临床医生应准确掌握重症肺炎合并急性呼吸窘迫综合征相关特征,对疑似病例积极给予各项检查确诊病情,根据其实际情况提供针对性的治疗措施,保障患者生活质量及生命安全.     

重症胸外伤合并呼吸窘迫综合征的诊疗方法

目的探讨重症胸外伤并发呼吸窘迫综合征的诊疗方法。方法对19例重症胸外伤合并急性呼吸窘迫综合征患者采用机械通气治疗，比较治疗前后PaO2、PaCO2、PaO2／FiO2，并给予患者保持呼吸道通畅，检测患者生命征的变化。结果所有患者除3例死于颅内再出血和多脏器功能衰竭外，其余均治愈出院。结论呼吸窘迫综合征一经确诊，应积极进行早期有效治疗，同时改善低氧血症是治疗呼吸窘迫综合征成功的关键。     

联合应用PS及机械通气治疗新生儿呼吸窘迫综合征

目的：探讨肺表面活性物质联合机械通气治疗新生儿呼吸窘迫综合征的疗效。方法：联合应用肺表面活性物质和机械通气治疗25例新生儿呼吸窘迫综合征患儿，对治疗前后临床表现、动脉血气、呼吸机参数、胸部X线变化等进行观察。结果：用药后患儿临床症状明显好转，胸部X线透亮度明显改善、颗粒网状阴影消失，血气分析及机械通气参数如FiO2、PIP、PEEP值明显降低（P〈0．01）。结论：肺表面活性物质联合机械通气能迅速有效地治疗新生儿呼吸窘迫综合征。     

血浆氨基末端B型脑钠肽前体在急性呼吸窘迫综合征中应用价值的分析

目的研究血浆氨基末端B型脑钠肽前体在急性呼吸窘迫综合征预后诊疗中的应用价值。方法抽取2012年3月~2014年3月入我院治疗的急性呼吸窘迫综合征患者42例作为观察组，抽取同期入院体检正常者45例作为对照组，分析两组患者血浆氨基末端B型脑钠肽前体(NT-proBNP)的变化情况。结果观察组患者NT-proBNP较对照组高，差异具有统计学意义(<0.05)。经治疗，急性呼吸窘迫综合征患者入院第1 d NT-proBNP水平无显著差异，存活组NT-proBNP水平明显下降趋势，死亡组则呈上升趋势，差异均具有统计学意义(<0.05)。结论NT-proBNP水平与急性呼吸窘迫综合征患者的预后存在直接关系，临床可根据NT-proBNP水平变化，了解其病情发展情况，对医师确定治疗方案具有重要意义。     

胸外伤致急性呼吸窘迫综合征15例诊疗体会

目的 总结胸外伤致急性呼吸窘迫综合征(ARDS)的诊断及治疗经验. 方法对我院自2004年1月至2008年12月收治的15例胸外伤致急性呼吸窘迫综合征(ARDS)病例资料回顾性分析. 结果 15例患者中13例治愈出院,2例死亡. 结论早期诊断、合理应用呼吸机及药物治疗是降低本病死亡率的有效措施.     

促纤维化蛋白WNT5A在脓毒症诱导的急性肺损伤的早期被激活

<正>急性呼吸窘迫综合征中肺损伤和纤维化的机制鲜为人知。WNT/β-连环蛋白信号通路的功能在肺修复和纤维化中日益受到重视,为了证实这条通路在脓毒症之后早期在肺组织中被激活。一组西班牙科学家在体外肺细胞损伤模型中将人支气管上皮细胞(BEAS-2B)和人胚肺成纤维细胞(MRC-5)暴露在内毒素中18 h,用盲肠末端结扎穿孔术诱发动物脓毒性急性呼吸窘迫综合征,并从因患败血症性急性呼吸窘迫综合征而死亡的病人身上提取死亡24 h的肺组织,通过免疫印迹和免疫组织     

肾移植术后肺部感染23例临床分析

目的分析肾移植术后肺部感染的临床特点和诊治措施。方法对23例肾移植术后并发肺部感染患者的临床资料进行回顾性分析。结果23例患者中巨细胞病毒感染9例,其中合并细菌感染2例。细菌感染7例,其中复合细菌感染1例,细菌合并真菌感染2例;肺部真菌感染4例。发生细菌败血症1例,真菌败血症1例。另3例未检出病原体。经综合治疗本组中22例治愈,1例死亡,为细菌合并真菌感染的重症肺部感染者,死亡原因为急性呼吸窘迫综合征。结论肾移植术后合并肺部感染病情复杂,死亡率较高;可靠的病原学诊断、及时而有效的综合治疗可提高其治愈率。     

肺表面活性物质在重症新生儿呼吸窘迫综合征中的应用

肺表面活性物质作为新生儿呼吸窘迫综合征的针对病因的特效医治措施,已成为其标准治疗手段之一,有效降低了新生儿呼吸窘迫综合征的并发症发生率及死亡率,但重症新生儿呼吸窘迫综合征仍是引起新生儿残疾和死亡最常见的疾病,因而应重视新生儿呼吸窘迫综合征严重度的评价,并制订出适用于重症新生儿呼吸窘迫综合征的治疗方案。     

肋骨环抱接骨器在肋骨骨折治疗中的应用

目的探讨肋骨环抱器在胸外伤肋骨内固定的治疗效果。方法本组113例肋骨骨折患者,在全身麻醉下分离肋骨断端两侧2cm,将接骨器放入冰水内5min使其软化,撑开接骨器环保臂,用湿纱布热敷3min,接骨器快速恢复原来形状并固定肋骨。其中74例行单纯肋骨固定,39例在其他手术过程中同期完成或第二期完成。结果本组113例,死亡2例,均为严重颅脑合并胸腹部联合伤,多器官功能衰竭;8例严重胸壁软化,其中6例出现急性呼吸窘迫综合征（ARDS）,经肋骨内固定后均痊愈。结论肋骨环抱器内固定简单易行,对于减轻伤者胸痛,改善咳嗽排痰效果十分明显,尤其适用于多根多处肋骨骨折者,可以防治ARDS,缩短呼吸机使用时间。     

急性呼吸窘迫综合征的药物治疗

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的防治是多途径、综合性的救治过程.目前尚无治疗急性肺损伤(acute lung injury,ALI)/ARDS的特效药物,对其有缓解作用的药物主要针对其的急性渗出期、炎症反应或氧化损伤以及纤维增生期.联合多种药理因素...     

The importance of surfactant on the development of neonatal pulmonary diseases

Pulmonary surfactant is a substance composed of a lipoprotein complex that is essential to pulmonary function. Pulmonary surfactant proteins play an important role in the structure, function, and metabolism of surfactant; 4 specific surfactant proteins have been identified: surfactant proteins-A, surfactant proteins-B, surfactant proteins-C, and surfactant proteins-D. Clinical, epidemiological, and biochemical evidence suggests that the etiology of respiratory distress syndrome is multifactorial with a significant genetic component. There are reports about polymorphisms and mutations on the surfactant protein genes, especially surfactant proteins-B, that may be associated with respiratory distress syndrome, acute respiratory distress syndrome, and congenital alveolar proteinosis. Individual differences regarding respiratory distress syndrome and acute respiratory distress syndrome as well as patient response to therapy might reflect phenotypic diversity due to genetic variation, in part. The study of the differences between the allelic variants of the surfactant protein genes can contribute to the understanding of individual susceptibility to the development of several pulmonary diseases. The identification of the polymorphisms and mutations that are indeed important for the pathogenesis of the diseases related to surfactant protein dysfunction, leading to the possibility of genotyping individuals at increased risk, constitutes a new research field. In the future, findings in these endeavors may enable more effective genetic counseling as well as the development of prophylactic and therapeutic strategies that would provide a real impact on the management of newborns with respiratory distress syndrome and other pulmonary diseases.     

Correction of NO-dependent pulmonary vasodilation disorder in cardiosurgical patients with acute respiratory distress syndrome

Disturbances in endogenous NO synthesis present an important pathogenetic mechanism of NO-dependent vasodilation disorder in patients with acute respiratory distress syndrome. Inhalational NO is an effective means of correcting NO-dependent pulmonary vasodilation and the pulmonary function of oxygenation in 47% of patients with acute respiratory distress syndrome.     

Efficacy of “Awake ECMO” for critical respiratory failure after pediatric open-heart surgery

A 4-year-old boy with atrioventricular discordance, double-outlet right ventricle, pulmonary stenosis, and mitral regurgitation, was undergoing anatomical repair consisting of Senning, Rastelli, Damus–Kaye–Stansel procedures, and a mitral valve repair, complained of post-operative excessive airway tract secretion, which ultimately developed into acute respiratory distress syndrome (ARDS) 28 days after the operation. The cause of the ARDS was thought to be frequent manual positive pressure recruitment and prolonged inhalation of pure oxygen. At 45 days after the operation, hypercapnia and respiratory acidosis turned out to be irreversible, and therefore, veno-arterial extracorporeal membrane oxygenation (ECMO) was established utilizing the Endumo^®4000 system. Pulmonic interstitial inflammation gradually improved while resting the lung under ECMO support; however, effective ventilation volume decreased critically because a massive pulmonary hemorrhage occurred at 2 and 9 days after the initiation of ECMO. To maximize the effectiveness of respiratory physical therapy, “Awake ECMO” was started and tidal volume dramatically increased with a regained cough reflex. Five days later, he was successfully weaned off from ECMO, and discharged 7 months after the operation without any neurological and physiological sequelae.     

Acute respiratory distress syndrome and blastomycosis: presentation of nine cases and review of the literature

Mississippi has the highest prevalence of blastomycosis in the country. In 20 years and 5 months there were 123 patients treated for blastomycosis at the University of Mississippi Medical Center. Among these, 107 patients had lung involvement and nine patients (8.4%) developed acute respiratory distress syndrome. Seven of the nine patients (78%) died of respiratory failure. In six patients, the lungs were the only organs involved. The three other patients had involvement of other organs as well. Average survival after the onset of acute respiratory distress syndrome was 6.9 days (range, 2 to 17 days). Acute respiratory distress syndrome can be triggered by pulmonary infections caused by bacterial diseases and other fungi. Massive proliferation of yeasts in the pulmonary parenchyma is the typical finding of patients with blastomycosis and acute respiratory distress syndrome. Underlying diseases that lead to immunodepression were present in only one patient and probable partial immunodepression was present in two other patients. Data from 19 other cases reported in the literature are discussed. Ann Diagn Pathol 5:1-9, 2001.     

Case of acute respiratory failure caused by drug-induced lung injury by shiniseihaito]

We present a case of acute respiratory distress syndrome (ARDS) caused by allergic reactions to shiniseihaito. An 84-year-old woman showed acute interstitial pneumonia followed by ARDS after taking shiniseihaito for the treatment of rhinitis. The ARDS were markedly improved with corticosteroid therapy. This case was diagnosed as being induced by shiniseihaito because it was compatible with 4 of 5 of Camus's criteria. The stimulation index of the drug lymphocyte stimulation test with shiniseihaito increased after corticosteroid therapy had been tapered and suggested that the mechanism of acute interstitial pneumonia in this case was allergic reaction induced by shiniseihaito. This is the seventh reported case of drug induced lung injury by shiniseihaito. We recommend careful observation when this medicine is prescribed.     

急性肺损伤/急性呼吸窘迫综合征与NF-κB信号转导关系的研究进展

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床上最常见的急危重症,其发病机制错综复杂,缺乏主动性治疗措施,病死率高。研究表明,核因子κB(NF-κB)为一种诱导型核转录因子,在ALI/ARDS发展过程中发挥极为广泛的功能,并与炎症反应具有密切的关系。现就ALI/ARDS、NF-κB信号转导通路及两者的关系作一简要的论述。