芒硝外敷全腹部在中-重度急性胰腺炎腹内高压合并ARDS中的应用

Application of mirabilite to external abdominal cavity for intra-abdominal hypertension of moderate to severe acute pancreatitis

目的通过使用芒硝外敷全腹部,探讨芒硝在中-重度急性胰腺炎腹内高压合并急性呼吸窘迫综合征(ARDS)中的作用。方法中-重度急性胰腺炎患者82例,随机分为对照组(n=39)和治疗组(n=43),两组患者入院后均按急性胰腺炎集束化治疗,但治疗组除以上治疗外,另予以芒硝外敷全腹部8～10 h,每天2次。收集患者一般资料,比较两组患者入院疗后第5天腹内压、APACHEⅡ评分、血清C反应蛋白含量,以及腹内压恢复正常时间、氧合指数恢复正常时间、机械通气时间、ICU住院时间。结果 (1)两组患者入院时一般资料差异均无统计学意义(P> 0. 05);(2)经治疗第5天,两组患者的平均腹内压(14. 59±4. 21vs 9. 30±2. 79,P <0. 001)、APACHEⅡ评分(10. 44±3. 03vs 7. 37±2. 21,P <0. 001)、血清C反应蛋白含量(50. 32±30. 37vs 31. 14±18. 00,P <0. 001)均较治疗第一天下降,但治疗组患者较对照组患者下降明显,且差异有统计学意义(P <0. 05);(3)治疗第5天,两组患者均病情好转后转专科或下级医院继续治疗,但治疗组患者腹内压恢复正常时间(6. 77±2. 44vs 4. 09±1. 59,P <0. 001)、氧合指数恢复正常时间(3. 67±1. 47vs2. 53±1. 18,P=0. 032)、机械通气时间(5. 62±4. 45vs 3. 21±2. 62,P=0. 003)、ICU住院时间(14. 72±5. 27vs 8. 28±2. 44,P <0. 001)均较对照组患者短,且差异有统计学意义(P <0. 05)。结论芒硝可有效降低中-重度急性胰腺炎患者腹内高压,缩短ARDS持续时间,值得临床推广。

Objective To explore the role of spreading mirabilite on external abdominal cavity in the treatment of the severe acute pancreatitis with intra-abdominal hypertension.Methods Eighty-two patients with moderate to severe acute pancreatitis were randomly divided into control group(n=39)and treatment group(n=43).Two groups of patients were treated by bundle therapy strategy for acute pancreatitis.In addition to the above treatment,the patients in treatment group were given mirabilite for 8~10 hours,2 times a day.The general data of the patients were collected.At the fifth day after admission,the abdominal pressure,APACHE II score,the serum level of C reactive protein,the time of abdominal pressure recovery and the time of oxygenation index recovery,the time of mechanical ventilation and the time of ICU stay were compared between the two groups.Results①There was no significant difference in general information between the two groups(P>0.05).②After 5 days treatment,the abdominal pressure(14.59±4.21 vs 9.30±2.79,P<0.001),APACHE II score(10.44±3.03 vs 7.37±2.21,P<0.001),the level of serum C reactive protein(50.32±30.37 vs 31.14±18.00,P<0.001)of two groups were decreased,while the decrease of these indexes in the treatment group were more significant than those in the control group(P<0.05).③After 5 days treatment,the conditions of two groups were improved.They were transferred to a Specialist or Lower Hospitals for further treatment.Compared to control group,the time of abdominal pressure recovery(6.77±2.44 vs 4.09±1.59,P<0.001),the time of oxygenation index recovery(3.67±1.47 vs 2.53±1.18,P=0.032),the time of mechanical ventilation(5.62±4.45 vs 3.21±2.62,P=0.003)and the time of ICU stay(14.72±5.27 vs 8.28±2.44,P<0.001)were significantly decreased.Conclusion Mirabilite can effectively decrease intra-abdominal hypertension in patients with moderate to severe acute pancreatitis,shortening the duration of acute respiratory distress syndrome(ARDS).It is worthy of clinical promotion.