肺挫伤并发急性肺损伤早期综合防治患者预后.docVIP

肺挫伤并发急性肺损伤早期综合防治患者预后 　关键词： 肺挫伤 　　 【摘要】 目的 分析和总结早期综合防治对严重肺挫伤并发急性肺损伤患者的预后影响。方法 回顾性分析54例严重肺挫伤并发急性肺损伤患者临床资料，所选患者根据伤后48h内确诊本病与否分2组，早期防治组(治疗组)：26例，对照组：28例。2组除处置原发伤，及早机械通气，给氧，抗感染及止血常规处理外，确诊本病后及时采用综合防治方案(甲基强的松龙250～500mg、白蛋白10g、速尿20mg，乌司他丁20万U+NS 20ml，1日2次静注。沐舒坦30mg，一日3次静注，及早肠内营养、合理容量支持)，调查分析2组的预后。结果 2组年龄(42.9±13.89/39.92±19.37)岁、入院时PaO2(68.4±15.76/67.63±15.01mmHg)、PaCO2(31.97±5.54/28.26±5.29mmHg)、APACHEⅡ评分(18.38±3.2/19.5±16.76)比较差异均无显著性(P均＞0.05)。治疗组综合防治方案治疗24h后PaO2增高(91.88±14.79mmHg)显著高于对照组(73.99±14.67mmHg)(P＜0.001)。治疗最终结果，治疗组ARDS、MODS、呼吸机相关性肺炎发生率和病死率(15.2%/7.69%/7.69%/3.85%)显著低于对照组(64.3%/35.71%/30.77%/30.77%)(P＜0.05/P＜0.025/P＜0.05/P＜0.05)。呼吸机使用天数(7.38±2.69/20.33±16.15)和住院日短于对照组(18.92±10.83/44.45±29.30)(均P＜0.001)。结论 早发现、早诊断、早期综合防治能有效改善严重肺挫伤并发急性肺损伤的发生和发展，也是改善患者预后的重要因素。 【关键词】 肺挫伤 急性肺损伤 早期综合防治 预后 Prognostic analysis of patients of pulmonary contusion with acute lung injury using early general prevention and management 【Abstract】 Objective To analyze and summarize the prognosis of patients of severe pulmonary contusion with acute lung injury(ALI)using early general prevention and management.Methods The clinical data of 54 cases were retrospectively analyzed.The patients were divided into two groups according to the diagnostic time:26 cases diagnosed in 48 hours were divided into the treatment group and 28 cases diagnosed after 48 hours were divided into the control group.Routine treatment was adopted in two groups，including management of the primary wound，mechanical ventilation in time，oxygen therapy，anti-infectious and hemostasia.And as soon as this disease was diagnosed，the general prevention and management were adopted，including methylprednisolone 250～500mg，serum albumin 10g，furosemide 20mg，ulinastatin 200 000u，bid iv，mucosolvan 30mg，tid iv，intestinal nutrition in time and liquid sustain reasonably.Results Before treatment，there was no significant difference(P＞0.05) between two groups about the ages(42.9±13.89 vs 39.9±19.37y)，PaO2 (68.4±15.76vs 67.63±15.01mmHg)，PaCO2(31.