急性重症胰腺炎并发急性呼吸窘迫综合征的预测因素与治疗进展

Predictive factors and treatment progress of acute severe pancreatitis complicated with acute respiratory distress syndrome

器官衰竭的出现与进展是急性重症胰腺炎患者死亡的主要原因之一。急性呼吸窘迫综合征(ARDS)是急性重症胰腺炎导致呼吸衰竭的主要原因,病死率较高。急性重症胰腺炎导致ARDS的发病机制尚不完全清楚,多种炎症细胞因子的释放在急性胰腺炎致ARDS的发生发展中起重要作用,各种毒素、炎症介质和胰酶引起的肠道通透性增加通过肠-肺轴加重肺损伤,导致细菌内毒素移位增加。各种评分系统、血清各细胞因子水平和肺部超声对急性胰腺炎并发ARDS的预测价值均有不同结果。各种药物在动物模型中已显示出预防和治疗ARDS的令人鼓舞的结果,但这些动物模型中的结果还有待于在临床研究中证实。目前ARDS尚无特效治疗方法,肺保护性通气策略对于改善急性胰腺炎合并ARDS患者的预后至关重要,消化内科和重症医学科需要有效协调,才能有效地治疗这类患者。

The occurrence and progression of organ failure is one of the main causes of death in patients with acute severe pancreatitis.Acute respiratory distress syndrome(ARDS)is the main cause of respiratory failure caused by acute severe pancreatitis.The pathogenesis of ARDS caused by severe acute pancreatitis is still not fully understood.The release of a variety of inflammatory cytokines plays an important role in the occurrence and development of ARDS caused by acute pancreatitis.The increase in intestinal permeability caused by various toxins,inflammatory mediators and pancreatic enzymes aggravates lung injury through the entero-lung axis,leading to increased translocation of bacterial endotoxins.There were different results on the predictive value of various scoring systems,serum cytokine levels and pulmonary ultrasound in ARDS complicated with acute pancreatitis.Various drugs have shown encouraging results in preventing and treating ARDS in animal models,but the results in these animal models have yet to be confirmed in clinical studies.At present,there is no specific treatment for ARDS,and lung protective ventilation strategy is crucial to improve the prognosis of ARDS patients with acute pancreatitis.Effective coordination between gastroenterology and intensive care medicine is needed to effectively treat these patients.