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超早期NPPV对重症胰腺炎致急性肺损伤的防治作用及对机体免疫反应机制研究
刘丹,刘纪宁,杨雍,黄彬,汤秦
0
(绵阳市中心医院急诊科)
摘要:
目的 探讨超早期无创正压通气(NPPV)对重症急性胰腺炎(SAP)致急性肺损伤(ALI)患者的防治作用及对患者外周血清中多种炎症因子的影响。方法 重症急性胰腺炎诊断明确,病史在3d以内,仅伴发呼吸增快≥30次/min、动脉血氧分压(Pa02)正常、且动脉血氧分压(Pa02)/吸氧浓度(FiO2)即氧合指数>300mmHg(正常)、尚未达到ALI/ARDS诊断标准的患者共46例。根据患者通气治疗情况分为超早期使用NPPV组(A组,n=23)和未通气组(B组,n=23),追踪两组患者接受通气治疗的情况,包括观察A组通气前、通气1h、撤机时的血气分析、SpO2及呼吸频率;比较两组ALI/ARDS发生率、使用有创通气的比率、ICU 入住时间、机械通气时间和病死率,以及两组患者外周血清中肿瘤坏死因子α(TNF)、白介素-6(IL-6)、白介素-8(IL-8)的含量。结果 A组23例超早期使用NPPV治疗,其中5例发展为ALI/ARDS,2例改用有创通气。B组23例未行超早期NPPV,15例发展为ALI/ARDS,8例行无创通气,7例改有创通气。A组的ICU入住时间短于B组(P<0.01),机械通气总时间亦短于B组(P<0.05),而两组病死率无差异(P>0.05)。两组外周血清中TNF、IL-6、IL-8含量入院后48h、出ICU时,A组各炎症指标均低于B组,差异有统计学意义(P<0.01)。结论〓对重症胰腺炎出现呼吸频率增快,还未达到ALI诊断标准的患者,超早期使用NPPV,此时患者气道分泌物少,意识清楚,人机配合好,可迅速纠正缺氧,阻止ALI进一步发展为ARDS,缩短机械通气时间,降低ICU入住时间,减轻全身炎症反应,但对病死率无明显影响。
关键词:  超早期  创通气  重症胰腺炎  ALI/ARDS  炎症因子
DOI:
基金项目:
Study on using ultra-early NPPV for the prevention and treatment of acute lung injury caused by severe acute pancreatitis and the mechanism of immune response
LIU Dan,LIU Jining,YANG Yong,HUANG Bin,TANG Qin
(Department of Emergency Medicine, Mianyang Central Hospital)
Abstract:
Objective To explore the effect of ultraearly NPPV on the prevention and treatment of ALI patients caused by SAP and the effect of ultra-early NPPV on various inflammatory factors in the peripheral blood of ALI patients caused by SAP. Methods 46 patients did not reach the ALI/ARDS diagnostic criteria were group A and group B. Group A was treated with early NPPV. Group B was without ventilation. The Blood gas analysis, SpO2 and respiratory rate were observed. The incidence of ALI/ARDS, the ratio of invasive ventilation, ICU occupancy time, mechanical ventilation time and mortality were observed. The serum TNF, IL-6 and IL-8 were measured. Results m There were 5 cases and 15 cases to develop to ALI/ARDS of group A and group B. ICU occupancy time and total mechanical ventilation time of group A were shorter than that of group B (P<0.01). There was no difference in mortality between the two groups (P>0.01). TNF, IL-6 and IL-8 of group A were lower than that of group B (P<0.01). Conclusion Early Use of NPPV is effective to treat acute lung injury caused by severe acute pancreatitis and the mechanism of immune response.
Key words:  Ultra-early  NPPV  Severe acute pancreatitis  ALI/ARDS  Inflammatory factors

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