重症急性胰腺炎并发急性呼吸窘迫综合征的临床治疗  

Retrospective analysis of the treatment of acute respiratory distress syndrome in severe pancreatitis

作　　者：雷洋[1] 彭进[1] 郑佳[1] 杨雪飞[1] 王耀丽[1] 李鹏飞[1] 周健[1] 

机构地区：[1]第三军医大学大坪医院重症医学科,重庆400042

出　　处：《中华肺部疾病杂志（电子版）》2016年第4期381-385,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金青年项目(81200057)

摘　　要：目的探讨重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)患者的临床治疗。方法收集我院2014年1月1日至2015年12月31日2年间首诊或发病48 h内入住ICU的20例重症急性胰腺炎并发ARDS患者的临床资料,以患者脱离呼吸机为观察终点,对其治疗方案及效果进行回顾性分析。结果 20例患者中,除1例因重度ARDS经治疗无好转出院外,其余患者取得良好治疗效果,并脱机拔管成功。结论重症急性胰腺炎并发ARDS患者早期采用有效液体复苏、肺保护性通气、早期液体负平衡、小剂量激素、俯卧位通气、早期肠内营养等措施,能有效治疗重症急性胰腺炎早期并发的ARDS,帮助患者渡过急性期;早期液体复苏具有关键作用,可以改善组织患者氧合和微循环灌注,以维护胰、肾脏和心脏灌注。Objective To investigate the epidemiology, the current status of clinical diagnosis and treatment and risk factors of acute lung injury/Acute Respiratory Distress Syndrome in Severe Pancreatitis. Methods All the medical records of 15 patients with acute lung injury in Severe Pancreatitis from January 2014 to December 2015 in the Daping Hospital were searched. Clinical characteristics, age, basic disease, clinical symptoms were analyzed. Results Among the 20 severe ALI/ARDS patients, there were 19 patients cured. Age, heart failure and septic shock were risk factors. Conclusions Severe systemic inflammatory response associated with the pulmonary infection and age might be important prognostic factor in the outcome of acute lung injury in Severe Pancreatitis. Early fluid resuscitation plays a critical role as it aims to improve tissue oxygenation and microcirculation perfusion in order to preserve not only pancreatic, but also renal and cardiac perfusion.

关 键 词：重症急性胰腺炎 急性呼吸窘迫综合征 液体复苏 治疗体会 

分 类 号：R563.1[医药卫生—呼吸系统]