抢救成功率。3.8支气管肺泡灌洗在机械通气48~72h后经纤维支气管镜直视下,注入生理盐水(37~38℃敏感抗生素和糖皮质激素行支气管肺泡灌洗,可有效清除ALI患者呼吸道内血痂、痰栓及分泌物,促进肺泡复张,改善肺功能。3.9其他治疗控制感染,对症治疗,控制原发病,同时营养支持。4展望综上所述,胸部手术中导致ALI的危险因素较多,机制也比较复杂,而随着研究的深入,对ALI的进一步了解,新的预处理或药物干预等方法的发现,新的治疗方式的探索,可以避免ALI的发生,降低病死率。从而可扩大肺部手术的适应证,提高手术成功率,也为肺移植、肺癌切除等手术提供新的思路和方法。参考文献[1]BemardGR,ArtigasA,BrighamKL,etal.TheAmerican2EuropenConsensnsConferenceonARDS:definitions,mechanisms,relevantoutcomes,andclinicaltrialcoordination[J].AmRevRespirDis,1994,149(3:8182824.[2]王祥瑞,杭燕南.急性肺损伤[M].北京:中国协和医科大学出版社,2005:1822184.[3]BoneRC.TowardanepidemiologyandnaturalhistoryofSIRS(systemicinflammatoryresponsesyndrome[J].JAMA,1992,268(24:345223455.[4]MatthayMA,ZimmermanGA,EsmonC,etal.Futureresearchdi2rectionsinacutelunginjury:summaryofaNationalHeart,Lung,andBloodInstituteworkinggroup[J].AmJRespirCritCareMed,2003,167(6:102721035.[5]潘铁成,郑智,周涛,等.肺癌全肺切除的术后并发症及其危险因素[J].华中科技大学学报,2004,33(1:2292231.[6]KotaniN,HashimotoH,SesslerDI,etal.Expressionofgenesforproinflammatorycytokinesinalveolarmacrophagesduringpropofolandisofluraneanesthesia[J].AnesthAnalg,1999,89(5:125021256.[7]吴畏,杨天德,陶军.异氟醚麻醉对内毒素诱导的大鼠急性肺损伤的预处理效应[J].临床麻醉学杂志,2002,18(10:31232.[8]PopovskyMA,AudetAM,AndrzewskiC.Transfusionassociatedcirculatoryoverloadinorthopedicsurgerypatients:amulti2institu2tionalstudy[J].Immunohematology,1996,12(2:87289.[9]SillimanCC,AmbrusoDR,BoshkovLK.Transfusion2relatedacutelunginjury[J].Blood,2005,105(3:226622273.[10]PartrickDA,MooreEE,OffnerPJ,etal.Maximalhumanneutro2philprimingforsuperoxideproductionandelastasereleasere2quiresp38mitogen2activatedproteinkinaseactivation[J].ArchSurg,2000,135(2:219.[11]廖志品,田玉科,张传汉.单肺通气时对血气值及肺分流量影响的临床研究[J].医学临床研究,2005,22(6:7692771.[12]WebbHH,TiemeyDF.Experimentalpulmonaryedemaduetoin2termittentpositivepressureventilationwithhighinflationpressuresprotectionbypositiveend2expiratorypressure[J].AmRevRespirDis,1974,110(5:5562565.[13]SlutskyAS.Lunginjurycausedbymechanicalventilation[J].Chest,1999,116(1:9215.[14]BladesB,PierontHC,ScmadiA,etal.Theeffectofexperimentallungischemiaonpulmonaryfunction[J].SurgForum,1953,4(2:2552258.[15]吴国荃,马麟麟,张玉海,等.725例900次尸体肾移植的临床报告[J].中华器官移植杂志,1994,15(1:15217.[16]陈胜喜,李国虎,龙隆.缺血预处理对肺保护的临床研究[J].湖南医科大学学报,1999,24(4:3572359.[17]王卓,王辰.逐步再灌注对肺再灌注损伤的影响[J].中华结核和呼吸杂志,2005,28(9:6422644.[18]MartinezM,DiazE,JosephD,etal.Improvementinoxygenationbypronepositionandnitricoxideinpatientswithacuterespiratorydistresssyndrome[J].IntensiveCareMed,1999,25(1:29236.[19]CranshawJ,GriffithsMJ,EvansTW.Thepulmonaryphysicianincriticalcare2part9:non2ventilatorystrategiesinARDS[J].Thorax,2002,57(9:8232829.[20]林福清.肺表面活性剂在急性呼吸窘迫综合征中的作用[J].医学综述,2006,12(2:1292131.[21]白春学.应用连续性血液净化救治急性呼吸窘迫综合征[J].肾脏病与透析肾移植杂志,2006,15(2:1372138.收稿日期:2007210201修回日期:2008201204我国出生缺陷的监测现状与干预模式探讨段捷华(广西壮族自治区贵港市妇幼保健院儿科,广西贵港537100:R715文献标识码:A:100622084(20...