重症急性胰腺炎并发急性肺损伤的早期机械通气治疗

The Role of Mechanical Ventilation in Severe Acute Pancreatitis complicated by Acute Lung Injury

目的探讨机械通气在重症急性胰腺炎并发急性肺损伤治疗中的作用。方法对2005年1月至2010年7月南京医科大学第一附属医院普外科收治的31例急性重症胰腺炎并发急性肺损伤病例进行回顾性分析。将所有病例分为Ⅰ组和Ⅱ组。Ⅰ组为面罩吸氧10L/min,PaO2≤60mmHg时行人工呼吸机辅助通气,Ⅱ组为面罩吸氧10L/min,PaO2≤90mmHg时行人工呼吸机辅助通气。结果全部病例在机械通气48h后,机体氧合得到明显改善。Ⅰ组病死率为46.6%(7/15),Ⅱ组的病死率为18.7%(3/16)。Ⅱ组机械通气时间较Ⅰ组明显缩短(P<0.05)。结论早期机械通气能够改善重症急性胰腺炎患者的氧合功能,及早机械通气治疗急性肺损伤有助于阻止其转变为急性呼吸窘迫综合征,降低病死率。

Objective To investigate the role of mechanical ventilation in severe acute pancreatitis complicated by acute lung injury.Methods The clinical data of 36 cases of severe acute pancreatitis with acute lung injury in the First Affiliated Hospital of Nanjing Medical University from January 2005 to July 2010 were analyzed retrospectively.All patients were divided into two groups.Patients in groupⅠ were mechanically ventilated when PaO2≤60mmHg（mask oxygen-inspiration,10L/min）.Patients in groupⅡ were mechanically ventilated when PaO2≤90mmHg（mask oxygen-inspiration,10L/min）.Results Significantly improved oxygenation was found in all cases 48h after mechanical ventilation.The mortality rate in group Ⅰwas 46.6%（7/15）,the mortality rate in group Ⅱ was 18.7%（3/16）.The mean duration of mechanical ventilation in group Ⅱ was shorter than group Ⅰ（P0.05）.Conclusions For patients suffering from severe acute pancreatitis with acute lung injury,early mechanical ventilation can improve oxygenation,help to prevent acute lung injury converting to acute respiratory distress syndrome and reduce the mortality rate.