早期有创机械通气治疗对急性重症胰腺炎预后的影响

Prognostic effect of early invasive mechanical ventilation on acute severe pancreatitis

关键词:  急性重症胰腺炎  急性呼吸窘迫综合征  机械通气

Key words:  severe acute pancreatitis  acute respiratory distress syndrome  mechanical ventilation

摘要:

目的　探讨有创机械通气的时机选择对急性重症胰腺炎并发急性呼吸窘迫综合征（ARDS）治疗的影响。方法　对2008年1月至2014年12月大连医科大学附属第一医院重症医学科收治的39例急性重症胰腺炎并发ARDS的患者进行回顾性分析。将所有病例分为Ⅰ组和Ⅱ组。Ⅰ组（n=14）为鼻导管吸氧6 L/min, PaO₂≤60 mmHg（氧合指数≤133 mmHg）时行有创人工呼吸机辅助通气；Ⅱ组（n=25）为鼻导管吸氧6 L/min，PaO₂≤90 mmHg（氧合指数≤200 mmHg）时行有创人工呼吸机辅助通气。观察患者氧合指数变化、机械通气时间、ICU留置时间及病死率。 结果　全部病例在机械通气6 h内机体氧合得到明显改善，Ⅰ组患者PaO₂由机械通气前(55.32±4.16)mmHg提高到（72.32±10.86)mmHg，Ⅱ组患者PaO2由机械通气前（76.45±10.22)mmHg提高到（98.56±6.81)mmHg。Ⅰ组患者治疗期间12例进展为ARDS（重度），Ⅱ组患者治疗期间10例进展为ARDS（重度），两组比较差异有显著性意义(P<0.05)。Ⅰ组病死率为35.7%(6/14)，Ⅱ组的病死率为 12.0%（3/25），两组比较差异有显著性意义（P<0.05）。Ⅱ组机械通气时间较Ⅰ组明显缩短(P<0.05)。结论　急性重症胰腺炎患者合并急性呼吸窘迫综合征时较早有创机械通气能够改善肺氧合功能，阻止急性呼吸窘迫综合征（轻中度）转变为急性呼吸窘迫综合征（重度），降低病死率。

Abstract:

Objective　To investigate the treatment timing of invasive mechanical ventilation on acute severe pancreatitis complicated by acute respiratory distress syndrome. Methods　A retrospective analysis of 39 patients, who were admitted in the Critical Care Medicine at the First Affiliated Hospital of Dalian Medical University due to severe acute pancreatitis complicated by acute respiratory distress syndrome from January 2008 to December 2014, was performed. All patients were divided into two groups: Group I patients received invasive mechanical ventilation when nasal cannula oxygen 6 L/min, PaO2≤60 mmHg（PaO₂/ FiO₂≤133 mmHg）; Group II patients received invasive mechanical ventilation when nasal cannula oxygen 6 L/min, PaO₂≤90 mmHg（PaO₂/ FiO₂≤200 mmHg）. PaO₂/ FiO₂ changes, duration of mechanical ventilation, ICU indwelling time and the death rate were studied. Results　After 6hs of mechanical ventilation, the oxygenation has been significantly improved in all patients. After mechanical ventilation, PaO2 changed from (55.32±4.16)mmHg to (72.32±10.86)mmHg in group I patients, (76.45±10.22)mmHg to (98.56±6.81) mmHg in group II patients. During treatment, 12 patients developed ARDS (severe) in group I, while 10 patients progressed to ARDS (severe) in group II (P<0.05). Group I fatality rate was 35.7%, group II fatality rate was 12%（P<0.05). Duration of mechanical ventilation in group II was significantly shorter than group I (P<0.05). Conclusion　Earlier invasive mechanical ventilation can improve oxygenation of severe acute pancreatitis patients who are complicated by acute respiratory distress syndrome, prevent moderate to severe acute respiratory distress syndrome and reduce fatality rate.