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目的探讨重症胸部创伤性呼吸窘迫综合征(ARDS)的肺保护性治疗方法。方法对28例重症胸部创伤性 ARDS患者应用综合性的肺保护性治疗,措施包括:个体化的肺保护性机械通气,大剂量肾上腺糖皮质激素冲击抗炎,小剂量高渗盐水迅速纠正休克和山莨菪碱改善肺微循环等。观察治疗后患者动脉血气改变,并检测治疗后1d、3d、7d 血清肿瘤坏死因子(TNFα)、白细胞介素-6(IL-6)的变化。结果治愈19例,治愈率67.9%,死亡9例,病死率32.1%;治疗后1～2 h 患者 PaO_2、PaCO_2、氧合指数(PaO_2/FiO_2)较治疗前有显著改善,P 均<0.05,3 d 后改善更为显著;治疗第3 d 血清 TNFα、IL-6即开始明显下降,与第1d 比较差异有显著意义,P<0.05。本组1例并发纵隔气肿,2例并发肺部感染外,未出现其它并发症。结论个体化的机械通气联合大剂量肾上腺皮质激素冲击疗法和山莨菪碱改善肺微循环等综合性肺保护性治疗措施,可明显提高重症胸部创伤性 ARDS 的疗效。
Objective To investigate the lung protective treatment of severe chest traumatic respiratory distress syndrome (ARDS). Methods A total of 28 cases of severe traumatic ARDS patients with pulmonary protective treatment, the measures include: individual lung protective mechanical ventilation, high-dose glucocorticoid impact anti-inflammatory, low-dose hypertonic saline to quickly correct shock and Anisodamine to improve lung microcirculation and so on. The change of arterial blood gas was observed after treatment, and the changes of serum tumor necrosis factor (TNF), interleukin-6 (IL-6) on the 1st, 3rd, 7th day after treatment were detected. Results The cure rate was 19.9%, the cure rate was 67.9%, and the death rate was 9%. The mortality rate was 32.1%. The PaO_2, PaCO_2 and PaO_2 / FiO_2 were significantly improved at 1 ~ After 3 d, the improvement was more significant. The levels of TNFα and IL-6 began to decrease obviously on the 3rd day after treatment, and there was significant difference compared with the 1st day (P <0.05). This group of patients with concurrent mediastinal emphysema, pulmonary infection in 2 cases, no other complications. Conclusions Individualized mechanical ventilation combined with high-dose corticosteroid shock therapy and anisodamine to improve lung microcirculation and other comprehensive protective measures of pulmonary protection can significantly improve the efficacy of severe chest traumatic ARDS.