急性光气中毒致皮下及-或纵隔气肿治疗.docVIP

急性光气中毒致皮下及/或纵隔气肿治疗【摘要】目的 探讨急性光气中毒所致纵膈、皮下气肿的临床特点及救治策略。方法 本研究中的81例患者均来自一起群体性光气中毒事件，排除既往有心肺等基础性疾病的患者。共有5例患者出现皮下和/或纵膈气肿，收集患者年龄、性别、动脉血气和呼吸机参数等临床资料，计量资料通过t检验进行统计学分析。结果 在5例并发皮下和/或纵膈气肿的患者中，男性3例，女性2例，平均年龄为（23.20±5.17）岁, 气肿发生率0.06%。经对症治疗后4例痊愈，1例因并发ARDS导致的顽固性低氧血症而死亡。同时，在出现气肿后，患者的动脉血气结果变化差异无统计学意义(P＞0.05)。结论 急性光气中毒重症患者出现皮下和/或纵膈气肿，与光气导致的肺损伤和治疗过程中呼吸机参数设置有关，在治疗过程中注意采用尽可能低的呼吸机支持条件是非常重要的。 【关键词】光气；皮下和/或纵膈气肿；治疗 Therapeutic strategies for dealing with cutaneous emphysema of chest wall and/or pneumomediastinum caused by severe triphosgene poisoning ZHANG Lin-lin，ZHOU Shu-sheng，SUN Zi-min，YANG Tian-jun，ZHU Shou-jun，FAN Hua，LIU Bao.省略 【Abstract】Objective To analyze the clinical features and the effect of therapy on cutaneous emphysema of chest wall and/or pneumomediastinum complicated in severe acute triphosgene poisoning patients.Methods Among 81 triphosgene poisoning patients, 5 complicated with cutaneousemphysema of chest wall and/or pneumomediastinum were analyzed in respect of the clinical data including age, gender, arterial blood gas (ABG), modes of mechanical ventilation support and so on. Results Five patients consisting of 3 males and 2 females, aged （23.20±5.17）years, were complicated with cutaneous emphysema of chest wall and/or pneumomediastium with a prevalence rate of 0.06%. Of them, 4 were alleviated completely and 1 died of acute respiratory distress syndrome (ARDS).There was no significant difference in arterial blood gas analysis (ABG) between patients with cutaneousemphysema and/or pneumomediastinum and patients without (P＞0.05).Conclusions Triphosgene-induced acute lung injury treated with mechanical ventilation support with high PEEP is highly suggested as high risk factor for the formation of cutaneous emphysema of chest wall and/or pneumomediastinum in severe acute Triphosgene poisoning patients. It is very important to set the PEEP level of mechanical ventilation support as low as possible for avoidance of alveolar rupture. 【Key words】Triphosgene; Cutaneous