Clowes G H, Hirsch E, Williams L, Kwasnik E, O'Donnell T F, Cuevas P, Saini V K, Moradi I, Farizan M, Saravis C
Ann Surg. 1975 May;181(5):681-92. doi: 10.1097/00000658-197505000-00024.
Two series of patients were studied by serial measurements of blood gas exchange and pulmonarmonary dysfunction and to evaluate the dangers of respiratory failure in post traumatic patients. There were 27 patients who had sustained profound hemorrhagic shock and massive blood replacement averaging 9.7 liters and 38 patients who suffered general peritonitis or other forms of fulminating nonthoracic sepsis. All were supported by endotrachael intubation and volume controlled ventilators. The overall mortality for the post shock patients without sepsis was 12% while in the septic patients it was 35%. The maximal pulmonary arteriovenous shunt encountered in the post hemorrhagic shock patients at 36 hours averaged 20 plus or minus 8% and was accompanied by high cardiac indices (average 5.1 plus or minus 1.3 L/M-2/min) but no significant rise of pulmonary arterial pressure or peak inspiratory pressure (PIP). Severe pulmonary dysfunction subsequently occurred only in those patients who later became septic. The studies on the septic patients were divided according to the magnitude of the cardiac indices (the high indices averaged 4.8 plus or minus 1.6L/M-2/min) and thelow indices averaged 1.9 plus or minus 1.0 L/M-2/min. In the former, the average maximal shunt of 30 plus or minus 6% was sustained for 4 or more days, accompanied by an elevation of PIP to 36 plus or minus 6 cm H2O and by Pa pressure of 28 plus or minus 5 mm Hg. The patients in low output septic shock usually had an associated bronchopneumonia and had an average venous admixture of 34 plus or minus 8% and PIP values of 41 plus or minus 8 cm H2O. The mean Pa pressure in this group was 29 plus or minus 6 mm Hg.
通过对两组患者进行血气交换和肺功能障碍的系列测量，来评估创伤后患者呼吸衰竭的危险性。一组有27例患者发生了严重失血性休克并大量输血，平均输血量为9.7升；另一组有38例患者患有弥漫性腹膜炎或其他形式的暴发性非胸部脓毒症。所有患者均通过气管插管和容量控制呼吸机进行支持治疗。无脓毒症的休克后患者总体死亡率为12%，而脓毒症患者的死亡率为35%。出血性休克患者在36小时时出现的最大肺动静脉分流平均为20±8%，同时伴有高心指数（平均5.1±1.3升/分钟/平方米），但肺动脉压或吸气峰压（PIP）无显著升高。严重的肺功能障碍随后仅发生在那些后来发生脓毒症的患者中。对脓毒症患者的研究根据心指数大小进行分组（高心指数组平均为4.8±1.6升/分钟/平方米，低心指数组平均为1.9±1.0升/分钟/平方米）。在高心指数组中，平均最大分流为30±6%，持续4天或更长时间，同时PIP升高至36±6厘米水柱，动脉血氧分压（Pa）为28±5毫米汞柱。低输出量脓毒症休克患者通常伴有支气管肺炎，平均静脉血掺杂为34±8%，PIP值为41±8厘米水柱。该组的平均Pa压力为29±6毫米汞柱。
