高水平呼气末正压通气与标准呼气末正压通气对重症急性胰腺炎伴急性呼吸窘迫综合征的疗效比较

High-level positive end expiratory pressure and standard positive end expiratory pressure on severe acute pancreatitis combined with acute respiratory distress syndrome: an efficacy comparison

目的:探讨高水平呼气末正压通气(PEEP)与标准PEEP对重症急性胰腺炎(SAP)伴急性呼吸窘迫综合征(ARDS)疗效的影响。方法:选取2013年12月至2016年12月期间阳山县人民医院确诊治疗的SAP伴ARDS患者100例,依据随机分配原则分为高P组和标P组,每组50例,标P组患者给予标准PEEP治疗,高P组患者给予高水平PEEP治疗。统计分析所有患者机械通气、住重症加护病房(ICU)时间、住院时间、呼吸机相关性肺炎(VAP)、死亡、治疗前和治疗后6、12 h氧利用率(O2UC)、治疗前后血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平。结果:高P组患者机械通气、住ICU时间、住院时间、VAP发生率、死亡率明显低于标P组,差异有统计学意义(P<0.05)。高P组和标P组患者治疗后6、12 h的O2UC水平均较治疗前升高,但前者较后者升高更显著,差异有统计学意义(P<0.05)。高P组和标P组患者治疗后血清TNF-α、IL-6水平均较治疗前下降,但前者较后者下降更显著,差异有统计学意义(P<0.05)。结论:与标准PEEP比较,高水平PEEP治疗可有效改善SAP伴ARDS患者的氧利用率和炎症状态,有效缩短机械通气、住ICU时间,有利于改善患者预后,值得临床进一步推广。

Objective To compare the therapeutic effect of high-level positive end expiratory pressure（PEEP） and standard PEEP on severe acute pancreatitis（SAP） combined with acute respiratory distress syndrome（ARDS）. Methods One hundred patients with SAP combined with ARDS, selected from patients admitted to Yangshan People＇s Hospital from December 2013 to December2016, were randomly divided into high-level P group and standard P group, 50 cases in each group. The patients in standard P group received standard PEEP treatment, while those in high-level P group received high-level PEEP treatment. The mechanical ventilation, intensive care unit（ICU） stay, hospital stay, the incidence of ventilator associated pneumonia（VAP）, mortality, oxygen utilization（O2UC） before treatment and that at 6 and 12 h after treatment, the serum tumor necrosis factor alpha（TNF alpha）and interleukin 6（IL-6） levels before and after treatment were statistically analyzed. Results The mechanical ventilation, ICU stay, hospital stay, the incidence of VAP and mortality in high-level P group were significantly lower than those in standard P group, with statistical differences（P〈0.05）. The O2UC levels at 6, 12 h after treatment in high-level P group and standard P group were higher than those before treatment, but the increase of the former was higher than that of the latter, with statistical differences（P〈0.05）. The serum TNF alpha, IL-6 levels after treatment in high-level P group and standard P group were lower than those before treatment, but the decrease of the former was more significant than that of the latter, with statistical differences（P〈0.05）.Conclusion Compared with standard PEEP, high-level PEEP therapy can effectively improve the oxygen utilization and the inflammatory state in patients with SAP combined with ARDS, and significantly shorten the time for mechanical ventilation,ICU stay, which are beneficial to the prognosis of patients. High-level PEEP therapy is worth for further clinical promotion.