胰腺炎相关ARDS的诊治进展  

Advances in the diagnosis and treatment of acute respiratory distress syndrome induced by pancreatitis

作　　者：王映珍[1] 蒙雁飞 马莉[1] 李培武[2] Wang Yingzhen;Meng Yanfei;Ma Li;Li Peiwu(Department of Intensive Care Unit,Second Hospital of Lanzhou University,Lanzhou 730030,Gansu,China;Emergency Center,Second Hospital of Lanzhou University,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院重症医学科,甘肃兰州730030 [2]兰州大学第二医院急救中心,甘肃兰州730030

出　　处：《中华危重病急救医学》2021年第9期1149-1152,共4页Chinese Critical Care Medicine

基　　金：甘肃省兰州市人才创新创业项目(2020-RC-96);甘肃省第七批科技计划(创新基地和人才计划)项目(21JR7RA396)。

摘　　要：急性胰腺炎(AP)是以胰腺急性炎症和腺泡细胞破坏为主要特征的消化系统常见疾病之一,常可发展为重症急性胰腺炎(SAP)。急性呼吸窘迫综合征(ARDS)为SAP最常见、最严重的并发症之一,也是导致SAP患者死亡的常见原因。近年来,虽然在SAP的发病机制及诊治等方面均有了新的认识,但多种在SAP动物模型中显示能够防治ARDS的药物并未在临床研究中改善SAP相关ARDS患者的预后。目前SAP相关ARDS的治疗仍遵循ARDS的一般治疗原则,如积极治疗原发病、肺保护性通气策略、俯卧位通气、早期短时间使用神经肌肉阻滞剂及体外膜肺氧合(ECMO)等,但对于SAP相关ARDS还应考虑到由于患者存在高腹内压、肠功能衰竭、腹部手术切口与引流管等因素对治疗措施的影响。本文就SAP相关ARDS诊治等方面的研究进展进行综述。Acute pancreatitis(AP)is one of the common diseases of the digestive system mainly characterized by acute inflammation of the pancreas and acinar cell destruction,and it can often develop into severe acute pancreatitis(SAP).Acute respiratory distress syndrome(ARDS)is one of the most common and serious complications of SAP and a common cause of death in patients with SAP.In recent years,there have gained new understanding of the pathogenesis,diagnosis,and treatment of SAP-related ARDS,however,a variety of drugs that have been shown to prevent ARDS in SAP animal models have not improved the prognosis of SAP-related ARDS patients in clinical researches.At present,the treatment of SAP-related ARDS still follows the general treatment principles of ARDS,such as treatment of primary disease,lung protective ventilation strategy,prone position ventilation,early short-term use of neuromuscular blockers and extracorporeal membrane oxygenation(ECMO),and so on.However,the influence of high intra-abdominal pressure,intestinal function failure,abdominal incision,and drainage tube on the treatment measures should also be considered for patients with SAP-related ARDS.This article reviews the recent progress in diagnosis and treatment of SAP-related ARDS.

关 键 词：急性呼吸窘迫综合征 急性肺损伤 重症急性胰腺炎 诊断 治疗 

分 类 号：R563.8[医药卫生—呼吸系统] R576[医药卫生—内科学]