急性重症胰腺炎合并急性呼吸窘迫综合征的综合治疗

Comprehensive Treatment for Acute Severe Pancreatitis Complicated with Acute Respiratory Distress Syndrome

目的:了解综合治疗手段对急性重症胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)的临床疗效。方法:采用综合治疗手段治疗34例SAP合并ARDS患者,包括常规治疗、血液净化和机械通气。观察患者的动脉血气分析结果、早期X光摄片检查结果和治疗效果。结果:SAP患者中59.65%并发ARDS。随着PaO2的降低,合并ARDS患者的比率越高;PaO2不同的三组患者并发ARDS比率的比较差异均有统计学意义(P<0.05)。SAP合并ARDS患者中有55.88%出现X光胸片变化。SAP合并ARDS患者中治愈22例,治愈率64.71%;死亡12例,死亡率35.29%。接受机械通气后SAP合并ARDS患者的PaO2/FiO2、PaCO2比机械通气前明显提高,比较差异均有统计学意义(P<0.05)。结论:临床治疗中应注意观察患者的动脉血气和胸肺部影像改变,尽早地发现SAP的并发症,有利于提高救治成功率,降低死亡率。

Objective：To find out the efficacy of comprehensive treatment for acute severe pancreatitis（SAP）complicated with acute respiratory distress syndrome（ARDS）.Method：Thirty-four SAP complicated with ARDS patients were treated with comprehensive treatment,including conventional treatment,blood purification and mechanical ventilation.The patient’s arterial blood gas analysis results,the early X-ray radiography examination results and treatment effect were observed.Result：59.65%of SAP patients complicated by ARDS.With the decrease in PaO2,the higher the ratio of the merger ARDS patients;ARDS ratios of three groups of patients with different PaO2 were significantly different（P〈0.05）.55.88%of SAP merger ARDS patients showed chest X-ray changes.22 SAP merger ARDS patients were cured,the cure rate of 64.71%;12 patients died,the mortality rate of 35.29%.After receiving mechanical ventilation,PaO2/FiO2 and PaCO2 of the SAP merger ARDS patients were significantly increased than before mechanical ventilation,the differences were statistically significant（P〈0.05）.Conclusion：In the clinical treatment physicians should observe the patient’s arterial blood gas and change in chest-lung imaging,early detection of complications of SAP,to improve the treatment success rate,reduce the mortality rate.