本文關(guān)鍵詞： 急性呼吸窘迫綜合征 兒童 臨床分析　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討兒童急性呼吸窘迫綜合征（ARDS）的致病及影響預(yù)后的危險(xiǎn)因素、診斷及治療，為臨床早期識(shí)別、合理治療提供理論參考。 方法：選擇2010年1月至2012年12月廣西醫(yī)科大學(xué)第一附屬醫(yī)院PICU病房住院診斷為急性呼吸窘迫綜合征的兒童（新生兒除外）病例資料進(jìn)行回顧性分析,并根據(jù)膿毒癥診斷標(biāo)準(zhǔn)將病例分為膿毒癥組和非膿毒癥組。 結(jié)果：1.診斷為ARDS患兒共34例，占同期患兒住院構(gòu)成比2%；病死數(shù)20例（包括放棄治療自動(dòng)出院后死亡7例），病死率58.8%；內(nèi)科疾病起源病例數(shù)30例（88.2%），外科疾病起源病例數(shù)4例（11.7%）；接受機(jī)械通氣28例（93.3%）,其中機(jī)械通氣大于72小時(shí)23例（76%）。 2.肺炎（無(wú)并發(fā)膿毒癥）12例（35.2%），為首要原發(fā)病，肺炎合并膿毒癥11例（32.3%)，為次要原發(fā)病。 3.對(duì)全部患兒機(jī)械通氣前、機(jī)械通氣后8小時(shí)、24小時(shí)、48小時(shí)、72小時(shí)的血?dú)夥治鲞M(jìn)行分析比較，非膿毒癥組患兒經(jīng)過(guò)呼吸機(jī)輔助通氣后72小時(shí)，PaO2和PaCO2得到顯著改善，PH、PaO2/FiO2無(wú)明顯改善；膿毒癥組患兒通氣后PH、PaO2、PaCO2、PaO2/FiO2均有顯著改善。 4.起病距原發(fā)病時(shí)間均值70.6±44.3小時(shí)（中位數(shù)72小時(shí)）。與非膿毒癥組比較,膿毒癥組患兒起病距離原發(fā)病時(shí)間更短（t=2.137，P=0.046）。 5.接受機(jī)械通氣的患兒潮氣量均值5.7±3.5ml/kg，符合小潮氣量通氣范圍；膿毒癥組與非膿毒癥組患兒機(jī)械通氣參數(shù)無(wú)顯著差異；1例患兒通氣后發(fā)生縱隔、皮下氣腫，呼吸機(jī)相關(guān)性肺損傷發(fā)生率2.9%。 6.本研究患兒ARDS最重要的致病因素為肺炎；單因素、多因素logistic回歸模型分析結(jié)果表明,本研究患兒疾病起源、基礎(chǔ)疾病、肺炎與ARDS預(yù)后顯著相關(guān)。 結(jié)論：1.兒童ARDS仍為高死亡率疾��；2.肺炎是兒童ARDS最重要的致病因素；3.保護(hù)性通氣是治療ARDS的重要策略
[Abstract]:Objective: to investigate the risk factors, diagnosis and treatment of acute respiratory distress syndrome (ARDS) in children. Methods: the data of children (except newborns) with acute respiratory distress syndrome (ARDS) in PICU ward of the first affiliated Hospital of Guangxi Medical University from January 2010 to December 2012 were retrospectively analyzed. The patients were divided into sepsis group and non-sepsis group according to the diagnostic criteria of sepsis. Results 1. 34 cases of ARDS were diagnosed. In the same period, 20 cases died (including 7 cases of death after automatic discharge from hospital, 58.8% of mortality), 30 cases of the origin of internal diseases, 4 cases of surgical diseases, 4 cases of surgical diseases, 28 cases of mechanical ventilation. Mechanical ventilation was more than 72 hours in 23 cases. 2. Pneumonia (12 cases without sepsis) was the primary primary disease, and 11 cases with pneumonia with sepsis were 32. 3%, which were secondary primary diseases. 3.The blood gas analysis of all the children before mechanical ventilation and after 8 hours 24 hours and 48 hours and 72 hours after mechanical ventilation showed that PaO2 and PaCO2 were significantly improved 72 hours after ventilator assisted ventilation in non-sepsis group. No significant improvement was found in PHPao _ 2 / FiO _ 2; In sepsis group, the Pao _ 2 / FiO _ 2 / FiO _ 2 ratio of Paco _ 2 and Paco _ 2 / FiO _ 2 were significantly improved after ventilation. 4. The mean time from onset to primary disease was 70.6 鹵44.3 hours (median 72 hours). Compared with non-sepsis group, the onset time of sepsis group was much shorter than that of non-sepsis group. 5. The mean tidal volume of children undergoing mechanical ventilation was 5.7 鹵3.5 ml / kg, which was in accordance with the range of low tidal volume ventilation, and there was no significant difference in mechanical ventilation parameters between sepsis group and non-sepsis group. One case developed mediastinum and subcutaneous emphysema after ventilation. The incidence of ventilator-associated lung injury was 2.9%. 6. The most important pathogenic factor of ARDS in this study was pneumonia, and the results of univariate and multivariate logistic regression analysis showed that the origin of disease, the underlying disease, pneumonia and prognosis of ARDS were significantly correlated in this study. Conclusion ARDS is still a high mortality disease in children 2.pneumonia is the most important pathogenic factor of ARDS in children 3.Protective ventilation is an important strategy in the treatment of ARDS.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725.6

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本文編號(hào)：1530613