急性重症胰腺炎并发急性呼吸窘迫综合征20例刍议

Discussion on 20 Cases of Acute Severe Pancreatitis Complicated with Acute Respiratory Distress Syndrome

目的分析急性重症胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)的临床特点与疗法。方法该研究对象为方便选取2018年4月—2020年4月间来院治疗的77例SAP患者,将并发ARDS的20例患者纳入A组,将未并发ARDS的57例患者纳入B组。分析A组的临床特点,筛查ARDS的易患因素。结果 ARDS的发生率为25.97%,普遍存在呼吸急促表现,呼吸频率平均值为(37.02±0.49)次/min。患者的发病时间多为发病或术后3 d内,占比80.00%;血气分析可见患者多伴有呼吸性碱中毒伴代谢性酸中毒(50.00%)和呼吸性碱中毒(35.00%)表现;影像学检查发现,肺不张占比15.00%,胸腔积液占比20.00%。A组的平均年龄是(55.24±5.34)岁,B组是(60.21±5.41)岁,差异有统计学意义(t=3.673,P<0.001);病因中,A组的胆源性因素占比50.00%,B组占比71.93%,差异有统计学意义(χ^(2)=4.863,P=0.027);A组的三酰甘油(TG)水平为(4.55±1.26)mmol/L,B组为(2.30±1.21)mmol/L,差异有统计学意义(t=7.325,P<0.001);A组的血氧分压(PaO2)水平为(60.28±5.34)mmHg,B组为(80.77±5.49)mmHg,差异有统计学意义(t=14.980,P<0.001);A组的氧合指数(简称OI)水平为(279.54±8.31)mmHg,B组为(372.65±8.41)mmHg,差异有统计学意义(t=44.253,P<0.001);A组的腹腔高压征、治愈、手术例数均低于B组;不同时间段的急性生理与慢性健康评分(APACHEⅡ)评分高于B组,差异有统计学意义(P<0.05)。结论 SAP并发ARDS具有明显的临床特点,易患因素为高三酰甘油血症与腹腔高压征,需要根据患者情况合理评估手术适应证,科学使用呼吸机,进而改善治疗预后。

Objective To analyze the clinical characteristics and treatment of acute severe pancreatitis(SAP)complicated by acute respiratory distress syndrome(ARDS).Methods The research object was to conveniently select 77 SAP patients who came to the hospital for treatment from April 2018 to April 2020.20 patients with ARDS were included in group A,and 57 patients without ARDS were included in group B.Analyze.the clinical characteristics of group A and screen the risk factors of ARDS.Results The incidence of ARDS was 25.97%.Tachypnea was common.The average respiratory rate was(37.02±0.49)breaths/min.The onset time of patients was mostly within 3 days after the onset of the disease,accounting for 80.00%;blood gas analysis showed that the patients were mostly accompanied by respiratory alkalosis with metabolic acidosis(50.00%)and respiratory alkalosis(35.00%);imaging examination found that atelectasis accounted for 15.00%and pleural effusion accounted for 20.00%.The average age of group A was(55.24±5.34)years old,group B was(60.21±5.41)years old,the difference was statistically significant(t=3.673,P<0.01);among the etiologies,biliary factors in group A accounted for 50.00%,and group B accounted for 71.93%,the difference was statistically significant(χ^(2)=4.863,P=0.027);the level of triacylglycerol(TG)in group A was(4.55±1.26)mmol/L,group B was(2.30±1.21)mmol/L,the difference was statistically significant(t=7.325,P<0.001);the partial pressure of oxygen(PaO2)in group A was(60.28±5.34)mmHg,and in group B was(80.77±5.49)mmHg,the difference was statistically significant(t=14.980,P<0.001);the oxygenation index in group A(OI)level was(279.54±8.31)mmHg,group B was(372.65±8.41)mmHg,the difference was statistically significant(t=44.253,P<0.001);the number of abdominal hypertension signs,cures,and operations in group A were lower than those in group B;the Acute Physiology and Chronic Health Score(APACHEⅡ)score of segment at different times was higher than that of group B,the difference was statistically significant(P<0.05).Conclusion SAP complicated with ARDS has obvious clinical characteristics.The risk factors are hypertriglyceridemia and abdominal hypertension.It is necessary to evaluate the surgical indications based on the patient's condition,and use the ventilator scientifically to improve the prognosis of treatment.