早期连续性肾脏替代治疗辅助地塞米松在急性重症胰腺炎合并急性呼吸窘迫综合征中的应用

Early Continuous Renal Replacement Therapy Combined with Dexamethasone in Acute Severe Pancreatitis with Acute Respiratory Distress Syndrome

目的探讨早期连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合地塞米松治疗急性重症胰腺炎(severe acute pancreatitis,SAP)合并急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的效果。方法回顾性分析62例SAP合并ARDS患者的临床资料,按治疗方案的不同分为参照组31例和观察组31例,在机械通气、抗感染等常规治疗基础上,参照组接受CRRT治疗,观察组接受CRRT联合地塞米松治疗。比较2组患者治疗后临床相关指标(血淀粉酶消失时间、尿淀粉酶恢复时间、胰腺水肿改善时间、腹痛缓解时间及住院时间),治疗前及治疗7 d后动脉血氧分压、氧合指数、炎性因子指标(白细胞介素-6、超敏C反应蛋白和肿瘤坏死因子-α)及病情相关评分(全身炎性反应综合征评分和急性生理与慢性健康评分)。结果观察组患者血淀粉酶消失时间、尿淀粉酶恢复时间、胰腺水肿改善时间、腹痛缓解时间及住院时间均短于参照组(均P<0.001)。治疗7 d后,观察组患者动脉血氧分压及氧合指数均高于参照组(均P<0.001);观察组患者白细胞介素-6、超敏C反应蛋白及肿瘤坏死因子-α水平均低于参照组(P<0.001或P<0.01);观察组全身炎性反应综合征评分和急性生理与慢性健康评分均低于参照组(P<0.001,P<0.05)。结论CRRT联合地塞米松治疗SAP合并ARDS患者可有效改善患者体内炎症状态及血气功能,加速病情恢复。

Objective To explore the efficacy of early continuous renal replacement therapy(CRRT)combined with dexamethasone in the treatment of patients with severe acute pancreatitis(SAP)and acute respiratory distress syndrome(ARDS).Methods Clinical data of 62 patients with severe acute pancreatitis(SAP)and acute respiratory distress syndrome(ARDS)was retrospectively analyzed.The patients were divided into a control group of 31 cases and an observation group of 31 cases according to different treatment methods.Apart from mechanical ventilation,anti-infection and other conventional treatments,the control group received CRRT treatment,whereas the observation group received CRRT combined with dexamethasone treatments.Clinical indicators(time for disappearance of blood amylase,time for recovery of urine amylase,time for improvement of pancreatic edema,time for relief of abdominal pain,and length of hospital stay)after treatment,arterial oxygen partial pressure,oxygenation index,inflammatory factor indicators(interleukin-6,hypersensitive C-reactive protein,and tumor necrosis factor alpha),and disease-related scores(systemic inflammatory response syndrome score,acute physiological and chronic health scores)before and after 7 days of treatment were compared between the 2 groups of patients.Results After treatment,time for disappearance of blood amylase,time for recovery of urine amylase,time for improvement of pancreatic edema,time for relief of abdominal pain,and length of hospital stay were shorter in the observation group than those in the control group(all P<0.001).After 7 days of treatment,arterial oxygen partial pressure and oxygenation index in the observation group were higher than those in the control group(all P<0.001);the average levels of interleukin-6,hypersensitive C-reactive protein,and tumor necrosis factor alpha in the observation group were lower than those in the control group(P<0.001 or P<0.01);the systemic inflammatory response syndrome score,acute physiological and chronic health scores in the observation group were lower than those in the control group(P<0.001,P<0.05).Conclusions CRRT combined with dexamethasone can potentially improve the inflammatory status and blood gas function,accelerate the improvement of the condition,and facilitate prognosis recovery in SAP patients with ARDS.