早期腹腔微创穿刺引流在重症急性胰腺炎肺损伤中的保护作用

Protective effect of early percutaneous catheter abdominal drainage on lung injury of severe acute pancreatitis

目的观察早期腹腔微创穿刺引流对重症急性胰腺炎(SAP)致急性肺损伤的保护作用,及其对临床疗效的影响。方法选取2016年10月至2018年2月重症医学科收治的SAP伴发腹腔积液患者114例,使用随机数字表法将患者分为对照组和观察组,每组57例。对照组采用常规基础的保守治疗,观察组在对照组治疗基础上加用腹腔微创穿刺引流。酶联免疫吸附法(ELISA)检测白介素(IL)-6和肿瘤坏死因子(TNF)-α等炎症因子水平。以动脉血氧分压(Pa O2)和氧合指数(Pa O2/吸入氧浓度,Pa O2/Fi O2)作为肺功能的监测指标,比较两组临床治疗效果。结果治疗前血浆IL-6和TNF-α水平两组间无统计学差异(P均> 0. 05)。与治疗前比较,治疗7 d后两组IL-6和TNF-α水平均降低(P均<0. 01),且观察组显著低于对照组(P均<0. 05)。治疗前Pa O2和Pa O2/Fi O2两组间无明显差异(P均> 0. 05)。与治疗前比较,治疗7d后两组Pa O2和Pa O2/Fi O2均显著升高(P均<0. 01),且观察组高于对照组(P均<0. 05)。治疗前腹腔内压力(IAP)和急性生理与慢性健康状况评分(APACHEⅡ)两组间无明显差异(P均> 0. 05)。与治疗前比较,治疗7 d后两组IAP和APACHEⅡ分均显著降低(P均<0. 01),且观察组显著低于对照组(P <0. 05,P <0. 01)。观察组有效率为89. 47%,显著优于对照组的73. 68%(P <0. 05)。结论早期腹腔微创穿刺引流可以显著降低SAP患者的炎症反应,保护肺功能,临床疗效显著。

Objective To observe the protective effect of early minimally invasive abdominal puncture drainage on lung injury caused by severe acute pancreatitis（SAP） and the influence on clinical efficacy. Methods A total of 114 patients with SAP associated with peritoneal effusion admitted to Intensive Care Unit from October 2016 to February 2018 were selected. The patients were randomly divided into control group and observation group（n = 57 each） by digital table method. The patients in control group were treated with conventional conservative treatment,and the patients in observation group were additionally treated with percutaneous catheter abdominal drainage on the basis of treatment of control group.Enzyme linked immunosorbent assay（ELISA） was used to detect the levels of plasma interleukin（IL）-6,tumor necrosis factor α（TNF-α） and other inflammatory factors. The arterial oxygen partial pressure（Pa O2） and oxygenation index（Pa O2/nspiratory oxygen concentration,Pa O2/Fi O2） were served as the monitoring indexes of lung functions. The clinical outcomes of the two groups were compared. Results There were no significant differences in plasma IL-6 and TNF-α levels before treatment between two groups（all P〈 0. 05）. The plasma IL-6 and TNF-α levels at 7 days after treatment decreased significantly in two groups compared with pre-treatment（all P〈 0. 01）,and they in observation group were significantly lower than those in control group（all P〈 0. 05）. Before treatment,there were no significant differences in Pa O2 and Pa O2/Fi O2 between two groups（all P〈 0. 05）. The Pa O2 and Pa O2/Fi O2 at 7 days after treatment increased significantly in both two groups compared with pre-treatment（all P〈 0. 01）,and they in observation group were significantly higher than those in control group（all P〈 0. 05）. There were no significant differences in intraabdominal pressure（IAP） and acute physiology and chronic health score（APACHE Ⅱ） before treatment（all P〈 0. 05）. The IAP and APACHE Ⅱ at 7 days after treatment decreased significantly in two groups compared with pre-treatment（all P〈 0. 01）,and they in observation group were significantly lower than those in control group（P〈 0. 05,P〈 0. 01）. The effective rate in observation group was significantly higher than that in control group（89. 47% vs 73. 68%,P〈 0. 05）. Conclusion The early percutaneous catheter abdominal drainage can significantly reduce the inflammatory response and protect the lung function and has significant clinical efficacy in SAP patients.