地塞米松防治急性重症胰腺炎患者早期机械通气治疗中肺损伤的作用分析  

Effect of dexamethasone on prevention and treatment of lung injury in early mechanical ventilation in patients with acute severe pancreatitis

作　　者：朱国强[1] ZHU Guo-qiang(The First Affiliated Hospital of Nanyang Medical College,Henan Nanyang 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院普通外科,河南南阳473000

出　　处：《医药论坛杂志》2020年第5期69-71,75,共4页Journal of Medical Forum

摘　　要：目的探析地塞米松在急性重症胰腺炎患者早期机械通气治疗中的应用对肺损伤的防治作用及作用机制。方法纳入本院EICU病房于2016年6月—2018年6月所收治的78例急性重症胰腺炎患者作为研究对象,按随机数字表分为观察组(n=40)与对照组(n=38)。两组均予以重症胰腺炎常规综合治疗,并于早期行机械通气治疗,观察组在此基础上连续3天静脉推注地塞米松(20 mg/d)。比较两组治疗前后(入院当天、入院第3 d及第5 d)的肿瘤坏死因子-α(TNF-α)、可溶性髓样细胞触发受体-1(sTREM-1)水平(双抗体夹心ELISA法检测)、机械通气时间、住院时间、治疗期间并发症发生率及死亡率。结果两组入院当天的TNF-α、sTREM-1水平无显著差异(P>0.05);入院3d及5d时观察组TNF-α、sTREM-1水平均低于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间与住院时间分别为(4.6±1.4)d、(14.2±3.8)d,均短于对照组,差异有统计学意义(P<0.05)。两组脓毒血症、急性肾损害、多器官功能衰竭等并发症发生率及死亡率的比较均无统计学意义(P>0.05)。结论地塞米松在急性重症胰腺炎患者早期机械通气治疗中的应用可有效降低患者TNF-α、sTREM-1水平,抑制炎性反应,减轻肺损伤,且可加快患者康复进度,缩短机械通气时间及住院时间,减少医疗花费,具有较高应用价值。Objective To explore the prevention and treatment effect and mechanism of dexamethasone on lung injury in patients with acute severe pancreatitis treated by early mechanical ventilation.Methods A total of 78 patients with acute severe pancreatitis admitted to our hospital from June 2016 to June 2018 were selected as research objects and randomly divided into observation group(n=40)and control group(n=38).Both groups received conventional comprehensive treatment for severe pancreatitis and received early mechanical ventilation.The observation group received intravenous injection of dexamethasone for 3 consecutive days on this basis.Tumor necrosis factor-strem-1 and soluble myeloid cell receptor 1(strem-1)levels,mechanical ventilation time,hospital stay,and complications were compared between the two groups before and after treatment.Results There was no significant difference in TNF-sTREM-1 between the two groups before treatment(P>0.05).Levels of TNF-sTREM-1 in the observation group were lower than those of the control group at admission day 3 and 5 d,and the difference was statistically significant(P<0.05).The duration of mechanical ventilation and hospitalization in the observation group were(4.6±1.4)d and(14.2±3.8)d,respectively,which were both shorter than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of sepsis,acute kidney damage,multi-organ failure and other complications and mortality between the two groups(P>0.05).Conclusion The application of dexamethasone in the early mechanical ventilation treatment of patients with acute severe pancreatitis can effectively reduce the level of TNF-sTREM-1,inhibit the inflammatory response,reduce lung injury,speed up the recovery of patients,shorten the duration of mechanical ventilation and hospitalization,and reduce the medical costs,which has high application value.

关 键 词：急性重症胰腺炎 机械通气 地塞米松 肺损伤 

分 类 号：R657.5[医药卫生—外科学]