老年胃肠道术后早期脱呼吸机病人并发ards的早期诊断与治疗.pptVIP

老年胃肠道术后早期脱呼吸机病人并发ARDS的早期诊断与治疗 武警湖北总队医院胃肠外科 ---孙宏斌 目的 【摘要】目的 探讨老年胃肠道术后早期脱呼吸机病人并发ARDS的早期诊断及干预性治疗。 方法 利用SIRS量化评分预估ARDS发展，一经明确后立即给予呼吸支持以及降低全身炎性反应综合征等治疗。 结果 317例老年胃肠道术后早期脱呼吸机病人中，用该方案评估，有23例被及时确诊为ARDS，并给予早期干预治疗，其中22例患者顺利康复痊愈，仅1例死亡，病死率4.3％。 结论 该诊疗方案可加强老年胃肠道术后早期脱呼吸机病人并发ARDS的预判准确性及干预治疗效果，明显降低了发病率和病死率。 【关键词】老年；早期脱呼吸机；ARDS；SIRS评分 Preventive Diagnosis and Treatment on Elderly Patients after Gstrointestinal Surgery Early off Ventilator with ARDS Complicated Sun Hongbin, (Gastrointestinal Surgery,Hubei Provincial Corps Hospital of Chinese People’s Armed Police Force,Hubei 430060,China) 【Abstract】 Objective To investigate the preventive diagnosis and treatment on elderly patients after gstrointestinal surgery early off ventilator with ARDS complicated. Methods To quantify the use of SIRS score predicted the development of ARDS, once the diagnosis is clear, given respiratory support, as well as SIRS in symptomatic treatment. Results 317 cases of elderly patients after gstrointestinal surgery early off ventilator by the use of such programs, 23 cases were diagnosed as ARDS in time, And provide early intervention therapy, of which 22 patients were successfully recovered , Only 1 patient died, mortality rate is 4.3%. Conclusion The treatment program will enhance the elderly patients after gstrointestinal surgery early off ventilator with ARDS complicated pre-judgment accuracy and intervention treatment.Significantly reduced the morbidity and mortality, improve survival. 【Key words 】Elderly; Early off ventilator; ARDS; SIRS score ARDS ARDS是老年胃肠外科危重患者术后最常见的并发症之一，病死率高。2000年以来我国流行病学调查资料显示其病死率高达50.0%～68.7%[1]，而对于术后早期脱呼吸机仅行普通病房监护的老年患者，管床医生易忽视，往往难以系统、准确评估ARDS的发生。针对一旦出现ARDS的高病死率，早期准确的评估、及时有效的治疗干预以及逆转ARDS是处理此病的重点。2006年4月～2009年3月我科老年胃肠道术后早期脱呼吸机病人就ARDS的评估、发生与发展以及早期干预治疗的心得体会进行总结。 1 资料与方法 1.1 一般资料 1.1.1研究对象 317例患者均来自我科住院病人，其中男221例，女96例，年龄60～85（平均年龄73.5）。术前诊断为胃肠外科常见疾病，如消化道溃疡并穿孔、胃癌、结直肠癌。患者均不同程度的合并有高血压、糖尿病、心肺功能不全等，无绝对手术禁忌证。所行手术有胃穿孔修补术、胃大部切除术、胃癌根治术、结直肠癌根治术以及因晚期癌症伴多处转移而行姑息造瘘术。麻醉方式均为静脉全麻