重症急性胰腺炎并发急性呼吸窘迫综合征的临床分析

Clinical analysis of acute respiratory distress syndrome secondary to severe acute pancreatitis.

目的探讨重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)患者的临床特点及治疗方法。方法SAP患者67例,按是否发生ARDS分为ARDS组和非ARDS组,观察两组患者的呼吸频率、APACHEⅡ评分、Ranson评分、胰腺CT评分、肠蠕动抑制发生率、胰腺感染率及病死率并进行比较。结果ARDS组死亡11例,病死率47.8%。ARDS组入院时呼吸频率、入院时及入院24hAPACHEⅡ评分、入院24hRanson评分、入院时胰腺CT评分、入院24h内肠蠕动抑制发生率以及胰腺感染率和病死率均明显高于非ARDS组(P<0.05或P<0.01)。结论SAP患者如入ICU和/或治疗24h后APACHEⅡ评分、Ranson评分、胰腺CT评分仍明显增高,或肠蠕动抑制仍不缓解,同时呼吸频率进行性加快时,要警惕ARDS发生。

Objective To analyze the clinical features and treatments of acute respiratory distress syndrome （ARDS） secondary to severe acute pancreatitis （SAP）. Methods 67 SAP patients were divided into ARDS group and non-AHDS group. The changes of respiratory rate, APACHE Ⅱ score, Hanson score, pancrease CT score, occurrence rate of inhibition of vermiculation,infectious rate of pancreas and fatality rate were compared between groups. Results 11 cases in 23 of ARDS group were dead,with mortality rate of 47.8%. The respiratory rate, APACHE Ⅱ score on admission and 24h after admission,24h Hanson score on admission,pancreas CT score on admission,occurrence rate of inhibition of vermiculatiion, infectious rate of pancrease and mortality rate within 24h after admission were significantly higher in ARDS group than those in non-ARDS group （ P〈0.05 or P〈0.01 ）. Conclusion The SAP patients are predisposed to ARDS when APACHE Ⅱ score, Ranson score, and pancreas CT score increase significantly,or the inhibition of vermiculatiion is not improved meanwhile the respiratory rate is progressively increased in ICU or after 24h treatment.