目的:探討自體血液回收技術對循環、血細胞和凝血功能的影響及應用效果。方法: 選擇急診大失血手術患者27例,采用ZITI-2000型血液回收機回收血液,經過濾、離心、清洗后回輸給患者。分不同時點觀察HR、SBP、MAP、DBP、SPO2的變化,并監測RBC、Plt、HB、Hct、FIB、PT、APTT的變化。計算輸血量和異體輸血率。隨機選擇8例進行回收原血和回輸 血血細胞學比較。結果:(1)術前血壓較低,心率較快,回輸血液后,HR顯著降低(Plt;0.01),SBP和MAP顯著升高(Plt;0.01)。(2)術前RBC、HB和Hct均低于正常水平,回輸后各時點均升高明顯(Plt;0.01)。術前FIB和Plt低于正常水平,回輸后各時點增高,但無顯著意義。PT、APTT無明顯變化。(3)回收原血平均每例3735mL,回輸血平均每例1589mL,異體輸血率為25％。(4)回輸血RBC、HB和Hct均顯著高于回收原血(Plt;0.01)。結論:自體血液回收技術用于臨床安全可靠,能有效維持循環的穩定,對凝血功能無明顯影響,節約血源,減少異體輸血。
ObjectiveTo summarize and analyze the clinical characteristics of patients with acute diffuse lung changes and respiratory failure.MethodsThe clinical data of patients in the Department of Critical Care Medicine, Dazhou Central Hospital between January 2016 and December 2018 were retrospectively collected, whose main clinical manifestation was acute respiratory distress syndrome with acute onset (<3 weeks) and main imaging manifestation was diffuse changes in both lungs. The clinical characteristics of patients were summarized, and the causes of the disease were explored.ResultsA total of 65 patients with acute diffuse lung changes and respiratory failure were enrolled, including 42 males (64.6%) and 23 females (35.4%). The average age was (57.1±18.4) years, the average time from onset to treatment was (7.5±5.9) d, and the average length of stay in the intensive care unit was (8.9±4.1) d. A total of 23 cases died, with a case-fatality rate of 35.4%. Among the 65 patients, there were 50 case (76.9%) of infectious diseases, including 36 cases of bacterial infections (including 4 cases of tuberculosis), 8 cases of viral infections (all were H1N1 infections), and 6 cases of fungal infections (including 1 case of pneumocystis infection); and there were 15 cases (23.1%) of non-infectious diseases, including 4 cases of acute left heart failure, 2 cases of interstitial pneumonia, 2 cases of vasculitis, 1 case of myositis dermatomyositis, 1 case of aspiration pneumonia, 1 case of acute pulmonary embolism, 1 case of acute drug lung injury, 1 case of neurogenic pulmonary edema, 1 case of drowning, and 1 case of unknown origin.ConclusionsInfectious diseases are the main cause of acute diffuse lung changes and respiratory failure, while among non-infectious diseases, acute heart failure and immune system diseases are common causes.
ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.