【摘要】 目的探讨肺挫伤（PC）后并发急性成人呼吸窘迫征（ARDS）高危因素并调查每一因素对发生ARDS的影响。方法收集胸部钝挫伤患者794例,均存活>24 h。复习临床医学记录和X线胸片或胸部CT扫描,104例被诊断为PC。根据胸部CT扫描结果计算挫伤容量百分数,并分析入院时肺功能变数（PaO₂/ FiO₂）、伤情特征、第1个24 h需要输血量（Tx）、年龄、损伤评分（ISS）、入院时血压。结果104例PC（36例双侧）被诊断,平均挫伤容量24.8%（16%～50%）。肺损伤容量≥20%为严重挫伤（n=72）,<20%为中度损伤（n=32）。ISS 16～24者32例,25～50者53例,51～75者19例。入院时收缩压<90 mm Hg者44例,第1个24 h输血量>10 U者22例,年龄>65岁15例,33例发生ARDS（31.7%）,PaO₂/FiO₂<200。死亡7例（21.2%）。全组研究变数明显与ARDS相关。结论PC≥20%、ISS>25、入院时低血压、第1个24 h需要输血量>10 U、年龄>65岁为PC并发ARDS的高危因素。此高危因素对改善急性肺损伤的治疗和预防ARDS的发生,将起一定作用。更多还原

【Abstract】 Objective To identify high risk factors for the development of acute respiratory distress syn- drome（ARDS）in pulmonary contusion（PC）and examine the contributions each factor to ARDS development.Meth- ods A total of 794 patients with blunt chest trauma were admitted to the intensive care units/or hospital and sur- vived>24 hours.The medical records,X-ray films/or chest CT scan of 104 cases diagnosed as having a PC were re- viewed for demographics.Using computer-generated three-dimensional reconstruction from admission chest computed tomographic scan,contusion volume was measured and expressed as a percentage of total lung volume.Admission pul- monary function variable（PaO₂/FiO₂）,injury characteristics,24h transfusion requirement,age,injury severity score （ISS）.Hypotension on admission（systolic blood pressure<90mmHg）were documented.Results 104 patients with PC（36 bilateral）were identified.The average severity of contusion was 24.8 %（range 16 %～50 %）.Contusion vol- ume as severe PC≥20%（n=72）and moderate PC<20 %（n=32）.ISS 16～24（n=32）,25～50（n=53）,51～75（n=19）.Admission systolic blood pressure<90mmHg（（?）=44）.Age year>65（n=15）.24 hours transfusion requirement>10 units（n=22）.Of these patients 33 cases（31.7 %）developed ARDS,PaO₂/FiO₂<200.Mortality 7 cases（21.2 %）.All studied variables were significantly associated with ARDS in universality analyses.Conclusion All studied,demonstrated PC≥20 %,age>65 years,ISS>25,hypotension on admission,24-hour transfusion requirement>10 units allows identification of patients a high risk factors in development ARDS.The high risk fac- tors providing the greatest contribution to improve therapy in acute lung injury and prevent ARDS to occur.更多还原