肾综合征出血热(HFRS)并发ARDS临床特征及抢救

目的　探讨肾综合征出血热 (HFRS)并发急性呼吸窘迫综合征 (ARDS)临床特征及诊断和抢救措施。方法　对 8例HFRS并发ADRS临床特征及血气、X检查进行分析诊断及其抢救措施。结果　 8例中 3例治愈(早期 2例 ,中期 1例 )。 5例死亡 (皆为中晚期 )。治愈率为 37 5% (3/ 8) ;病死率 6 2 5% (5/ 8)。结论　ARDS发病期别与预后关系较大。其发病机理主要是各种致病因素 ,尤其是严重感染和休克 ,使体内产生大量炎性介质、可使毛细血管扩张 ,通透性增加 ,引起间质性肺水肿。由于中性粒细胞和血小板被活化 ,可释放大量自由基 ,使肺微血管损伤和通透性增加 ,使肺含水量增高所致。救治措施 ,积极治疗和纠正原发病 ,迅速纠正缺氧 ,限制液体入量 ,早期使用胶体液 ,减轻肺水肿。早期大量肾上腺皮质激素应用 ;α受体阻滞剂 -酚氨拉明及抗胆碱能药物 -东莨菪碱应用 ,均对改善肺水肿有益。

Clinical Characteristics and Rescue Analysis of HFRS Complicated with ARDS

Objective To study the clinical characteristics, diagnosis and rescue measure of HFRS complicated with ARDS. Methods The data of blood gas and x-ray were analyzed and diagnosed in 8 patients of HFRS complicated with ARDS and meanwhile clinical characteristics and rescue measure were analyzed. Results 2 patients in early period and one in middle period were cured. 5 patients died in middle-later period. The curative rate was 37.5% (3/8) and mortality was 62.5% (5/8). Conclusions The period that ARDS occurred was related to prognosis. The pathogenesis was mainly all kinds of pathogenic factors, especially serious infection and shock. They produced large amount of inflammatory medium and expanded blood capillary and improved the penetration that caused pulmonary intercellular edema. The free radical was discharged after activation of granulocyte and platelet and could cause pulmonary capillary damage and penetration increased. Finally, the pulmonary edema was resulted. Rescue measure could be treating primary disease positively, correcting anoxia quickly, controlling the amount of liquid infused and alleviating pulmonary edema. It could reach the good effect when use of adrenocortical hormones, a-adrenoreceptor blocking drug-phentolamine and anticholinergic drug-scopolamine early.