摘要
目的急性呼吸窘迫综合征(acute respiratory distress syndrom,ARDS)为严重多发伤常见而危及生命的严重并发症,是导致病死的主要原因之一。早期识别ARDS并根据其高危因素采取相应的救治措施为抢救重点。本研究对严重多发伤患者发生ARDS高危因素进行分析,提出相关的治疗措施并探讨其救治效果。方法选择2017-01-01-2020-01-31扬州东方医院呼吸与危重症医学科收治住院的严重多发伤患者为研究对象,将合并ARDS的59例患者作为病例组,未合并ARDS的21例患者作为对照组。采用单因素及多因素Logistic回归分析合并ARDS的高危因素。结果单因素分析结果显示,年龄(χ^2=5.693,P=0.017)、腹腔脏器损伤(χ^2=4.943,P=0.026)、肺部损伤(χ^2=16.610,P<0.001)、吸烟(χ^2=6.792,P=0.009)及胃内容物误吸(χ^2=8.437,P=0.004)与严重多发伤患者ARDS有关。多因素Logistic回归分析结果显示,吸烟(OR=2.28,95%CI为1.36~3.81,P=0.002)、有肺部损伤(OR=2.32,95%CI为1.68~13.53,P<0.001)、有胃内容物误吸(OR=1.02,95%CI为1.01~3.89,P=0.009)以及有腹腔脏器损伤(OR=2.26,95%CI为1.22~4.16,P=0.009)是严重多发伤合并ARDS的独立危险因素。59例严重多发伤合并ARDS患者中,34例抢救成功,18例抢救无效死亡,7例转上级医院治疗,抢救成功率为57.63%。结论腹内脏器损伤、肺部损伤、吸烟、胃内容物误吸是严重多发伤合并ARDS的危险因素。应严格把握诊断标准,做到早发现、早治疗、早处理,积极治疗原发疾病,合理使用呼吸机,加强多科的合作,以提高抢救成功率。
OBJECTIVE Acute respiratory distress syndrome(ARDS)is a common and life-threatening complication of severe multiple trauma,which is one of the main causes of death.Early identification of ARDS and taking corresponding curing measures according to its high factors are the focus of rescue.This study analyzed the high-risk factors of ARDS in patients with severe multiple trauma,put forward relevant treatment measures and explore the treatment effect.METHODS From January 1,2017 to January 31,2020,patients with severe multiple injuries admitted to the Department of Respiratory and Critical Care Medicine of Yangzhou Oriental Hospital were selected as the research objects.A total of 59 patients with ARDS were selected as the case group,and 21 patients without ARDS as the control group.Univariate and multivariate logistic regression were used to analyze the risk factors of ARDS.RESULTS Univariate analysis showed that age(χ^2=5.693,P=0.017),abdominal organ injury(χ^2=4.943,P=0.026),lung injury(χ^2=16.610,P<0.001),smoking(χ^2=6.792,P=0.009)and aspiration of gastric contents(χ^2=8.437,P=0.004)were associated with ARDS.Multivariate Logistic regression analysis showed that smoking(OR=2.28,95%CI:1.36-3.81,P=0.002),lung injury(OR=2.32,95%CI:1.68-13.53,P<0.001),aspiration of gastric contents(OR=1.02,95%CI:1.01-3.89,P=0.009)and abdominal organ injury(OR=2.26,95%CI:1.22-4.16,P=0.009)were the independent risk factors for severe multiple injuries complicated with ARDS.Among 59 patients with severe multiple trauma complicated with ARDS,34 cases were rescued successfully,18 cases died of invalid rescue,and 7 cases were transferred to higher level hospital for treatment.The success rate of rescue was 57.63%.CONCLUSIONS Abdominal organ injury,lung injury,smoking and aspiration of gastric contents are the risk factors of severe multiple trauma complicated with ARDS.We should strictly grasp the diagnostic criteria,early detection,early treatment,early treatment,active treatment of primary diseases,rational use of ventilator,strengthe
作者
陈国清
王斌
CHEN Guo-qing;WANG Bin(Department of Respiratory and Critical Care Medicine,Yangzhou Oriental Hospital,Yangzhou 223009,P.R.China)
出处
《社区医学杂志》
2020年第18期1278-1281,共4页
Journal Of Community Medicine
关键词
严重多发伤
急性呼吸窘迫综合征
脏器损伤
肺部损伤
胃内容物误吸
severe multiple trauma
acute respiratory distress syndrome
organ injury
lung injury
aspiration of gastric contents
