重症急性胰腺炎合并急性呼吸窘迫综合征的临床分析

Clinical analysis of severe acute pancreatitis complicated with acute respiratory distress syndrome

目的探讨重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者的临床特点和治疗经验。方法回顾分析2004年至2007年诊治的93例SAP及合并ARDS患者的临床特点和预后。结果 SAP合并ARDS患者在入院时的Ranson评分、APACHEⅡ评分、胰腺CT严重度指数、发病72 h时脏器功能障碍数目和未合并ARDS的患者有显著差异(P<0.01)。SAP患者的死亡率为21.5%(20/93),其中合并ARDS患者死亡率为35.0%(14/40);而未合并ARDS患者的死亡率为11.3%(6/53)(P<0.01)。SAP发病72 h以内发生ARDS的患者的死亡率为55.6%(10/18),于SAP发病72 h后发生ARDS的患者的死亡率为18.2%(4/22)(P<0.05),两者从SAP发病至死亡的时间分别为(7.3±5.0)d和(15.3±8.4)d,有显著性差异(P<0.05)。合并ARDS的SAP患者在死亡时平均累计有3.5个脏器功能障碍。结论 SAP合并的ARDS发生越早,死亡率越高。密切监测ARDS的高危患者,并在ARDS早期即给予保护性的呼吸机辅助通气,有助于ARDS的救治和降低SAP的死亡率。

Objective To investigate the clinical characteristics and treating experiences for patients of severe acute pancreatitis（SAP） complicated with acute respiratory distress syndrome（ARDS）.Methods The clinical characteristics and outcomes of 40 patients of SAP complicated with ARDS between 2004 and 2007 were analyzed retrospectively.Results The Ranson score,APACHEⅡ score,pancreatic CT severity index at admission and the number of dysfunctional organ at 72 hour after the onset of SAP were much higher for patients with ARDS than for those without ARDS（P〈0.01）.The overall mortality was 21.5%（20/93） for patients with SAP,35.0%（14/40） for those combined with ARDS and 11.3%（6/53） for those without ARDS（P〈0.01）.Among SAP patients complicated with ARDS,the mortality was 55.6%（10/18） for those occurring ARDS following the onset of ASP within 72 hours while it was 18.2%（4/22） for those occurring ARDS following the onset of SAP after 72 hours（P〈0.05）.Their time intervals from SAP onset to death were（7.3±5.0） days and（15.3±8.4） days,with significant differences,P〈0.05.Conclusion The earlier ARDS combined with SAP occurs,the higher the mortality is.It could be beneficial to lower the mortality of SAP and to treat ARDS if close monitoring for patients at high risk and protective mechanical ventilation at early stage are performed.