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Severe thoracic trauma complicated diagnosis and treatment of acute respiratory distress syndrome


Of: Ye Xian, Zhou Yin-North, Zhang Zhong Yuan, Tang Jun, 1997 ~ 2006 were treated in our hospital 219 cases of severe chest trauma, acute respiratory distress syndrome (ARDS) 32 cases, incidence rate of 146% , 28 cases were cured, 4 died, mortality was 125%, the report is summarized as follows. 1 clinical data Chinese papers League finishing. 11 general information the whole group of 32 patients, 22 males and 10 females. Age 20 to 50 years, mean 27 years old. Traffic accident in 25 cases,[link widoczny dla zalogowanych], 5 cases of crush injury, fall injury in 2 cases. Had severe chest trauma: multiple rib fractures, lung contusion, hemothorax merger and (or) pneumothorax; 1 case of traumatic asphyxia. 4 cases with head injury, 5 patients with fractures, 9 patients with traumatic shock. 12 treatments on the early diagnosis of ARDS, timely and reasonable treatment [1]: (1) ARDS generally ineffective oxygen therapy, early endotracheal intubation mechanical ventilation, endotracheal intubation more than 3 days tracheotomy. (2) aggressive treatment of primary disease. (3) The groups were intubated with mechanical ventilation SIMV + PEEP mode, PEEP was 5 ~ 10cmH2O. (4) of ARDS patients with adrenal cortex hormones [1] can reduce the damage of alveolar capillaries and reduce pulmonary vascular permeability, lysosomal membrane stability, improve the body's stress and tissue hypoxia, relieve bronchial spasm and microcirculation. General principles for the early use of high-dose, short (not more than 3 days), the group using dexamethasone 40 ~ 60 mg / d. (5) Antibiotics: severe chest trauma complicated with decreased immunity in patients with ARDS, pulmonary contusion, expectoration weakened easily lead to lung infections, rational use of antibiotics is very important. (6) protection of Ambroxol line lung function, the daily capacity of 180 mg. (7) nutritional support and prevention of complications, ARDS patients in a high catabolic state, protein consumption increased significantly, the need for adequate nutritional support. 13 treatment, and outcomes All patients underwent mechanical ventilation SIMV + PEEP mode, ventilation time 2 to 12 days. Tracheotomy in 20 cases, 25 patients with closed thoracic drainage, thoracotomy to stop bleeding in 2 cases, craniotomy to remove the hematoma in 2 cases, and to give the brake chest pain relief, antibiotics, hormones and other comprehensive treatment of ambroxol. 4 deaths (multiple organ failure, MSOF). 2 discussions Early diagnosis is important for saving time, ARDS signs of symptoms of chest trauma are often concealed and difficult to find early and delayed treatment [2 ]. The group meet diagnostic criteria for the literature [3,4] a serious chest injury appears to dyspnea, respiratory rate> 28 times / min, irritability, poor conventional oxygen therapy; chest X ray showed increased lung markings, edge blur patch like a shadow or a large shadow, and exclusion of chronic lung disease and left heart failure, blood gas analysis showed hypoxemia (PaO2 ≤ 60 mmHg), PaO2/FiO2 ≤ 300 mmHg, to take active measures.