早期胸腔穿刺引流对重症急性胰腺炎急性肺损伤的影响  

Effect of early thoracic paracentesis drainage on acute lung injury in severe acute pancreatitis

作　　者：王旭阳 王张鹏 吴俊 景光旭[2,3] 黄竹 孙红玉 汤礼军 WANG Xuyang;WANG Zhangpeng;WU Jun;JING Guangxu;HUANG Zhu;SUN Hongyu;TANG Lijun(College of Medicine,Chongqing Medical University,Chongqing 400016,China;PLA Center of General Surgery,The General Hospital of Western Theater Command,Chengdu 610083,China;College of Medicine,Southwest Medical University,Luzhou,Sichuan 646000,China;College of Medicine,Southwest Jiaotong University,Chengdu 610063,China;Basic Medical Laboratory,The General Hospital of Western Theater Command,Chengdu 610083,China)

机构地区：[1]重庆医科大学临床医学院,重庆400016 [2]西部战区总医院全军普通外科中心,成都610063 [3]西南医科大学临床医学院,四川泸州646000 [4]西南交通大学医学院,成都610063 [5]西部战区总医院基础医学实验室,成都610083

出　　处：《临床肝胆病杂志》2023年第7期1633-1642,共10页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81772001);国家临床重点专科项目(41732113)。

摘　　要：目的 探讨重症急性胰腺炎(SAP)伴发的少、中量胸腔积液早期穿刺引流对SAP患者急性肺损伤的影响。方法 回顾性分析中国人民解放军西部战区总医院 2015 年 1 月-2021 年 12月收治的107例 SAP 患者临床资料,根据入院后前3天是否进行胸腔穿刺置管引流,分为胸腔穿刺置管引流组(TPD组,51例)和非胸腔穿刺置管引流组(N-TPD组,56例)。分别比较入院后第5天、第10天两组相应时间节点实验室指标及临床结局。正态分布或近似正态分布的计量资料两组间比较采用成组t检验,非正态分布的计量资料两组间比较采用 Mann-Whitney U检验,计数资料两组间比较采用χ^(2)检验。结果 TPD组重症监护病房住院时间、总住院时间、住院费用明显少于N-TPD组(P值均<0.05);而 TPD组与N-TPD组患者病死率(9.8%vs 14.3%,χ^(2)=0.502,P=0.478)、脓毒症发生率(29.4%vs 44.6%,χ^(2)=2.645,P=0.104)比较差异无统计学意义。TPD组急性呼吸窘迫综合征(ARDS)发生率明显降低(χ^(2)=6.038,P=0.043),且中度ARDS发生率显著低于N-TPD组,差异有统计学意义(7.8%vs 21.4%,χ^(2)=3.874,P=0.049)。TPD组患者机械通气使用率明显低于N-TPD组(35.3%vs 57.2%,χ^(2)=6.735,P=0.034),且有创机械通气患者,TPD组明显低于N-TPD组(9.8%vs 26.8%,χ^(2)=5.065,P=0.024)。TPD组肺部感染发生率显著低于N-TPD组(23.5%vs 42.9%,χ^(2)=4.466,P=0.035),TPD组全身炎症反应综合征持续时间缩短[(11.2±5.0)d vs (16.8±4.7)d,t=5.949,P<0.001]。在入院后第5、10天,TPD组患者实验室指标(超敏C反应蛋白、IL-1、IL-6、IL-8和TNF-α、动脉血气氧分压、氧饱和度、氧合指数)、呼吸衰竭发生率均显著优于N-TPD组(P值均<0.05)。入院后第10天,TPD组APACHEⅡ评分、改良Mashall评分均显著优于N-TPD组(P值均<0.05)。结论 对于SAP伴发少、中量胸腔积液患者,早期进行胸腔穿刺引流,可有效改善患者的急性肺损伤,减轻全身炎症反应,缩短住院时间,减少住院Objective To investigate the effect of early thoracic paracentesis drainage for pleural effusion with a small or moderate volume on acute lung injury in patients with severe acute pancreatitis(SAP).Methods A retrospective analysis was performed for the clinical data of 107 patients with SAP who were admitted to The General Hospital of Western Theater Command from January 2015 to December 2021,and according to whether thoracic paracentesis drainage was performed within the first three days after admission,the patients were divided into thoracic paracentesis drainage group(TPD group with 51 patients)and non-thoracic paracentesis drainage group(N-TPD group with 56 patients).The two groups were compared in terms of laboratory markers and clinical outcome on days 5 and 10 after admission.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Results Compared with the N-TPD group,the TPD group had a significantly shorter length of stay in the intensive care unit,a significantly shorter length of hospital stay,and significantly lower hospital costs(all P<0.05),while there were no significant differences between the TPD group and the N-TPD group in mortality rate(9.8%vs 14.3%,χ^(2)=0.502,P=0.478)and the incidence rate of sepsis(29.4%vs 44.6%,χ^(2)=2.645,P=0.104).The TPD group had a significant reduction in the incidence rate of acute respiratory distress syndrome(ARDS)(χ^(2)=6.038,P=0.043),as well as a significantly lower incidence rate of moderate ARDS than the N-TPD group(7.8%vs 21.4%,χ^(2)=3.874,P=0.049).Compared with the N-TPD group,the TPD group had a significantly lower rate of use of mechanical ventilation(35.3%vs 57.2%,χ^(2)=6.735,P=0.034)and a significantly lower proportion of patients receiving invasive mechanical ventilation(9.8%vs 26.8%,χ^(2)=5.065,P=

关 键 词：胰腺炎 胸腔积液 引流术 急性肺损伤 全身炎症反应综合征 

分 类 号：R576[医药卫生—消化系统] R563[医药卫生—内科学]