目的:探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法: 选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输 血血细胞学比较。结果:(1)术前血压较低,心率较快,回输血液后,HR显著降低(Plt;0.01),SBP和MAP显著升高(Plt;0.01)。(2)术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显(Plt;0.01)。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。(3)回收原血平均每例3735mL,回输血平均每例1589mL,异体输血率为25％。(4)回输血RBC、HB和Hct均显著高于回收原血(Plt;0.01)。结论:自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。
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.