影响无创正压机械通气治疗急性重症胰腺炎患者有效性的因素分析

Analysis of the Factors Affecting the Effect of NIPPV in the Treatment of Patients with Severe Acute Pancreatitis

目的分析NIPPV治疗急性重症胰腺炎患者的临床转归，探讨影响NIPPV治疗急性重症胰腺炎有效性的因素。方法采用回顾性分析的方法，将2004年1月～2008年12月收入综合ICU并接受NIPPV治疗的急性重症胰腺炎患者，根据NIPPV治疗是否有效，将患者分为有效组和无效组进行对照研究。结果共有42例患者进入该研究，其中有效组25例，无效组17例。人院时两组患者除血浆白蛋白水平外，其他临床资料及Ranson评分的差异均无统计学意义。导致患者急性呼吸衰竭的诱因以急性肺损伤为主（60％），在无效组中则主要为肺部感染（76．4％）。患者人院时的血气分析显示两组患者动脉血氧分压均明显低于正常（63．01±8．03mmHg，61．21±10．74mmHg，P〉0．05），且无明显差异，经1hN1PPV治疗后，有效组患者动脉血氧分压脉明显提高，无效组则改善不明显，二者具有明显统计学差异（99．9±30．1mmHg，63．8±11．9mmHg，P〈0．05）。结论影响NIPPV治疗急性重症胰腺炎患者急性呼吸衰竭有效性的因素，与患者的血浆白蛋白水平和发生急性呼吸衰竭的诱发因素相关，以急性肺损伤为诱发因素者，更适于接受NIPPV治疗；动脉血氧分压能预测NIPPV疗急性重症胰腺炎患者的有效性。

Objective To analyze the outcome of the patients with severe acute pancreatitis who accept NIPPV in order to look for the factors which are effective for the patiens.Method From January 2004 to December 2008, a retrospective review of 42 SAP patiens who had ever accepted NIPPV in our intensive care unit was carried out. According to the outcome of the patiens, the patiens were divided into effective group and invalid group.Results There were 25 patiens in effective group, 17 patiens in invalid group.Both groups had a similar clinical data and Ranson score except blood albumin. In effective group,the most common factor causing acute respiratory failure was acute lung injury（about 60%）,but in invalid group it was pneumonia（about 76.4%）.When admitted in ICU,PaO2 of both groups were lower than the normal [the means is （63.01±8.03）mmHg and （61.21 ±10.74） mmHg,P〉 0.05 ]without distinction,but after accepting NIPPV for 1 hour, PaO2 of the patiens in effective group was obviously raised, in invalid group it is not well improved. There was statistical significance between the two groups [the means were （99.9 ±30.1）mmHg and （63.8 ±11.9） mmHg,P〈0.05].Conclusions The factors affecting the effect of NIPPV is not only concerned with blood albumin but also with the motivation, if the motivation is acute lung injury, it is the good indication of NIPPV;PaO2 can predict the efficacy of NIPPV used in SAP patiens.