早期持续性血液滤过联合无创正压通气治疗重症急性胰腺炎合并急性呼吸窘迫综合征的疗效分析

Effects of early continuous hemofiltration combined with non-invasive positive pressure ventilation in the treatment of severe acute pancreatitis with acute respiratory distress syndrome

目的:探讨早期持续性静脉-静脉血液滤过(Continuous veno-venous hemofiltration,CVVH)联合无创正压通气(Non-invasive positive pressure ventilation,NPPV)治疗重症急性胰腺炎(Severe acute pancreatitis,SAP)合并急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)的疗效。方法:选取我院2021年7月至2022年4月收治的158例SAP合并ARDS患者,根据治疗方案不同,分为NPPV组、血液滤过联合组(n=79),分别采用NPPV治疗以及在NPPV基础上早期(发病<6 h)进行CVVH治疗。比较两组临床症状缓解时间、机械通气时间、ICU住院时间。治疗7 d后,采用急性生理与慢性健康状况评分Ⅱ(Acute physiology and chronic health evaluation II,APACHEⅡ)评估患者的病情严重程度;采用血气分析仪测定氧合指数(Oxygenation index,PaO2/FiO2)、血氧分压(Blood oxygen partial pressure,PaO2)、二氧化碳分压(Carbon dioxide partial pressure,PaCO_(2));采用经尿道膀胱压力测定法检测患者的腹腔内压(Intra-abdominal pressure,IAP);使用酶速率法测定患者的血淀粉酶(Blood amylase,AMS)、尿淀粉酶(Urine amylase,UAMY);采用酶联免疫吸附法测定患者的血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-1β(Interleukin-1β,IL-1β);使用实时荧光定量PCR测定血清生长抑制特异性转录本5(Growth arrest-specific transcript,GAS5)表达。结果:血液滤过联合组腹痛腹胀缓解时间、胰腺水肿改善时间、首次排便或排气时间、机械通气时间、ICU住院时间均短于NPPV组(P<0.05);治疗7 d后,血液滤过联合组PaO2/FiO2、PaO2水平高于NPPV组,APACHEⅡ评分、PaCO_(2)、IAP、AMS、UAMY、CRP、TNF-α、IL-1β、GAS5水平低于NPPV组(P<0.05)。结论:早期CVVH联合NPPV治疗SAP合并ARDS患者,能有效缓解临床症状,改善血气指标水平,降低炎性因子水平,促进患者康复。

Objective:To investigate the effects of early continuous veno-venous hemofiltration(CVVH)combined with non-invasive positive pressure ventilation(NPPV)in the treatment of severe acute pancreatitis(SAP)with acute respiratory distress syndrome(ARDS).Methods:One hundred and fifty-eight patients with SAP and ARDS admitted to our hospital from July 2021 to April 2022 were collected and divided into the NPPV group and the hemofiltration combined group(n=79)according to different treatment schemes.All patients were treated with NPPV,and CVVH at an early stage(<6 h)based on the NPPV,respectively.The clinical symptom relief time,mechanical ventilation time,and ICU hospitalization time were compared between the two groups.After 7 days of treatment,acute physiology and chronic health evaluation II(APACHE II)was used to assess the severity of the patient's condition;a blood gas analyzer was used to measure the oxygenation index(PaO2/FiO2),blood oxygen partial pressure(PaO2),and carbon dioxide partial pressure(PaCO2);transurethral bladder pressure measurement was used to measure the intra-abdominal pressure(IAP);enzyme rate method was used to measure blood amylase(AMS)and urine amylase(UAMY);enzyme-linked immunosorbent assay was used to measure serum levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-1β(IL-1β);real-time fluorescence quantitative PCR was used to measure the growth arrest-specific transcript 5(GAS5)expression.Results:The time for relief of abdominal pain and abdominal distension,improvement of pancreatic edema,time for first defecation or exhaust,time for mechanical ventilation,and ICU hospitalization in the hemofiltration combined group were shorter than those in the NPPV group(P<0.05).After 7 days of treatment,the levels of PaO2/FiO2 and PaO2 in the hemofiltration combined group were higher than those in the NPPV group,and the APACHEⅡscore,the levels of PaCO2,IAP,AMS,UAMY,CRP,TNF-α,IL-1β,GAS5 were lower than those in the NPPV group(P<0.05).Conclusion:Early CVVH combined with NPPV can effectively relieve the clinical symptoms,improve the blood gas index level,reduce the level of inflammatory factors,and promote the rehabilitation of patients with SAP and ARDS.