【摘要】 目的：探讨腹部急症手术后肺损伤的预防和治疗。方法：回顾性分析４０例外科危重病人（ＡＰＡＣＨＥⅡ＞８分）首次手术后２４小时内的ＰａＯ２／ＦｉＯ２、ＡａＤＯ２和呼吸频率（ＢＲ）与急性肺损伤（ＡＬＩ）的关系，分为ＡＲＤＳ组（ Ⅰ组，１２例）和急性肺功能不全组（Ⅱ组，２８例），同时分析液体治疗和机械通气模式在防治ＡＲＤＳ中的作用，并计算死亡率。结果： Ⅰ组的ＰａＯ２／ＦｉＯ２、ＡａＤＯ２、ＢＲ和死亡率分别为１８．２±４．5ｋＰａ、２６８．７±４１．３ｍｍＨｇ、３３．７±６．９次／分和４１．７％（５／１２）；Ⅱ组则分别为２３．０±５．9ｋｐａ、２４３．８±５３．１ｍｍＨｇ、２６．９±７．６次/分和３．６％（１／２８）。结论：外科危重病人术后２４小时内往往伴有不同程度的急性肺损伤，极易发生ＡＲＤＳ；ＰａＯ２／ＦＩＯ２和呼吸频率是早期发现ＡＲＤＳ的临床指标；控制补液量、早期给予激素和尽早加用ＰＥＥＰ（呼气末正压）是防治ＡＲＤＳ的三大重要措施。更多还原

【Abstract】 Objective: To explore the prophylactic and therapeutic strategies of acute pulmonary injury after emergency laparotomy. Methods: The relationship between postoperative pulmonary injury within 24 hours after operation and alteration of ventilation parameters was retrospectively analyzed. Forty patients with critically ill diseases were divided into ARDS group(n=12) and acute pulmonary dysfunction group(n=28) according to the APACHEⅡ score, the effects of fluid resuscitation and mechanical ventilation in managing ARDS were evaluated. The mortality was calculated simultaneously. Results: The ventilation parameters including the PaO2/FiO2, AaDO2 and breathing rates were 18.2kPa±4.5kPa, 35.8kPa±5.5kPa and 33.7 times/min±6.9 times/min in ARDS group, while those in acute pulmonary dysfunction group were 23.0kPa±5.9kPa, 32.5kPa±7.08kPa and 26.9 times/min±7.6 times/min. The mortality were 41.7%(5/12) and 3.6%(1/28) in both groups respectively. Conclusions: Mile to severe acute pulmonary injury may occur within 24 hours postoperatively in critically ill patients, which might be a major cause of ARDS. PaO2/FiO2 and breathing rates are sensitive parameters for early detection of ARDS. The limitation in fluid infusion, early administration of steroid and PEEP mechanical ventilation are main three methods in proventing and treating acute pulmonary injury.更多还原