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； Wounds and injuries； Altitude； Oxygen dynamics▲
严重创伤并发成人呼吸窘迫综合征(ARDS)时，死亡率高达50%～70%，但在高海拔地区有关报道甚少。笔者旨在通过对20例ARDS患者的氧动力学监测，初步了解ARDS患者氧输送变化规律，为临床治疗提供理论依据。
资料与方法
1.一般资料：我科自1991年12月～1998年2月共收治胸外伤为主的全身多发伤94例，均出现呼吸衰竭需要呼吸机支持呼吸。按1992年欧美联席ARDS专题会议制定的标准，结合本地区特点，对符合ARDS诊断标准的20例患者进行了氧动力学监测。存活13例，死亡7例。男
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