|
西宁地区严重创伤患者并发成人呼吸窘迫综合征氧动力学变化 |
| |
马四清
摘 要：目的 探讨西宁地区严重创伤后并发成人呼吸窘迫综合征（ARDS）时氧动力学变化，为治疗提供理论依据。 方法 利用Swan-Ganz导管及热稀释法心输出量测定技术对20例ARDS患者进行监测。 结果 （1）监测开始1～2 d存活组和死亡组的氧输送（DO2） 逐渐上升，氧耗量(VO2) 也随之上升，出现病理性氧供依赖(r=0.6176,P<0.05) ，两组间比较无显著性差异。（2）抢救4～5 d以后，存活组患者DO2 仍继续升高，VO2也升高（r=0.6547，P<0.05）,但当DO2达到700 ml.min-1.m-2时，VO2上升缓慢，出现“平台效应”，而死亡组尽管临床上最大限度地提高了DO2，但VO2仍与DO2呈病理性依赖（r=0.7493,P<0.05）。（3）两组的氧摄取率（O2ext）在整个监测期间均处于较低水平。 结论 严重创伤后ARDS患者氧摄取已出现明显障碍，从而导致VO2 对DO2 发生氧供依赖，在治疗中应当将DO2水平尽可能提高到700 ml.min-1.m-2以上。
关键词：呼吸窘迫综合征，成人； 创伤和损伤； 高海拔； 氧动力学
Oxygen dynamic change in severely injured patients complicated with acute respiratory distress syndrome in Xining area
MA Siqing
（Intensive Care Unit, Qinghai Provincial People's Hospital, Xining 810007, China）
Absract：Objective To discuss the changes of oxygen delivery in the severely injured patients complicated with acute respiratory distress syndrome (ARDS) in Xining. Methods Twenty severely injured patients complicated with ARDS were monitored by Swan-Ganz catheter and thermodilution . Results The oxygen delivery (DO2) and oxygen consumption (VO2) of both the survival group (Group S) and the death group (Group D) increased in 1-2 days. A pathological oxygen supply dependence emerged (r=0.6176,P<0.05). However, there were no significant differences between Group S and Group D. After 4-5 days of treatment, VO2 and DO2 in Group S increased (r=0.6547, P<0.05). When DO2 reached 700 ml.min-1.m-2,VO2 increased slowely, and then a “platform effect” occurred. The oxygen extraction rate (O2ext) in both groups was low during the monitoring. Conclusions The compensation functions of the O2ext in the severely injured patients complicated with ARDS show obvious disorders which leading to the oxygen supply dependence of VO2 to DO2. Therefore, it suggests that DO2 should reach 700 ml.min-1.m-2 or more in the treatment.
Key words：Respiratory distress syndrome, adults； W[1] [2] 下一页
上一个医学论文： 脊髓型颈椎病手术治疗的远期疗效
下一个医学论文： 颌面部爆炸伤愈合过程中血管相关生长因子变化和作用的实验研究
|
|
|
|
|
|
|
您现在的位置： 绿色健康网 >> 医学论文 >> 外科论文 >> 正文