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目的 :充分了解和掌握高原地区ARDS患者氧输送变化规律 ,为临床治疗提供理论依据 ;方法 :利用Swan -Ganz导管及热稀释法输出量测定技术对西宁地区 2 0例ARDS患者进行监测 ;结果 :①监测开始第 1天至第 2天全部患者氧输送 (DO2 )逐渐上升 ,氧耗量 (VO2 )也随之上升 ,出现病理性氧供依赖 (r=0 .6 1 76 ,P <0 .0 5) ;②在抢救的第 4到第 5天以后成活组患者DO2 水平仍有继续升高 ,但VO2 上升趋势平缓 ,出现平台效应 ,DO2 与VO2 相关关系下降 (r=0 .457,P <0 .0 5) ,死亡组患者DO2 及VO2 再无升高 ,两者继续呈明显氧供依赖 (r =0 .7493,P <0 .0 5) ;③氧摄取率在整个监测期间均处于较低水平 ;结论 :ARDS患者氧摄取的代偿功能出现明显障碍 ,从而导致VO2 对DO2 发生氧供依赖 ,另外成活组患者存在临界DO2 、DO2 与VO2 能否重建新的平衡关系是抢救成败的关键
Objective: To fully understand and master the variation of oxygen delivery in patients with ARDS in plateau area, and to provide a theoretical basis for clinical treatment.Methods: Swan-Ganz catheter and thermodilution method were used to monitor 20 ARDS patients in Xining area.Results: (1) On the first day to the second day of monitoring, the oxygen delivery (DO2) of all the patients gradually increased and the oxygen consumption (VO2) also increased with the pathological oxygen dependence (r = 0.6166, P <0. (2) The level of DO2 in survivors continued to increase after the fourth and fifth days of resuscitation, but the rising trend of VO2 was gentle and the platform effect appeared. The correlation between DO2 and VO2 decreased (r = 0.457, P <0. 05). No significant increase in DO2 and VO2 was observed in the death group, both of which continued to show significant oxygen dependency (r = 0.7449, P <0.05). The rate of oxygen uptake during the whole monitoring period Conclusion: The compensatory function of oxygen intake in patients with ARDS appears obvious obstacles, resulting in VO2 dependent oxygen supply to DO2. In addition, the survival of patients with critical DO2, DO2 and VO2 can reconstruct the new balance between the success or failure of the rescue key