摘要
目的探究血液净化联合机械通气治疗重症急性胰腺炎致急性呼吸窘迫综合征的临床效果及对呼吸机相关肺炎(VAP)发生率的影响。方法方便选取该院2019年5月—2021年6月收治的52例重症急性胰腺炎致急性呼吸窘迫综合征患者,随机将其分为研究组(n=26)与对照组(n=26)。研究组使用血液净化联合机械通气治疗,对照组使用机械通气治疗。比较两组炎症因子水平变化情况、相关预后指标变化情况、呼吸机相关肺炎(VAP)发生情况与病死率。结果研究组治疗前PCT水平为(27.0±9.2)μg/L,hs-CRP水平为(142.2±46.8)mg/L;对照组治疗前PCT水平为(26.7±8.9)μg/L,hs-CRP水平为(138.3±44.2)mg/L;两组治疗前的炎症因子水平比较,差异无统计学意义(t=0.120、0.309,P>0.05)。经治疗后,研究组PCT水平为(11.3±4.9)μg/L,hs-CRP水平为(78.1±35.8)mg/L;对照组PCT水平为(19.1±6.4)μg/L,hs-CRP水平为(103.4±33.7)mg/L;研究组PCT水平及hs-CRP水平比对照组显著更低,两组比较差异有统计学意义(t=4.934、2.624,P<0.05)。研究组总机械通气时长为(5.0±1.3)d、腹胀与腹痛症状消失时间为(3.1±0.3)d、胰腺水肿情况得到改善时间为(6.1±1.4)d及住院时间为(9.5±1.3)d;对照组总机械通气时长为(8.1±2.5)d、腹胀与腹痛症状消失时间为(4.7±0.4)d、胰腺水肿情况得到改善时间为(7.9±1.8)d及住院时间为(16.1±2.4)d,对照组相关预后指标比研究组差,两组比较差异有统计学意义(t=5.609、16.316、4.025、12.331,P<0.05)。对照组VAP发生率38.5%、病死率19.2%比研究组11.5%、3.8%高,两组比较差异有统计学意义(P<0.05)。结论血液净化联合机械通气治疗重症急性胰腺炎致急性呼吸窘迫综合征的临床效果显著,能够有效改善患者病情,减轻炎症反应,VAP发生率降低,可在临床推广。
Objective To explore the clinical effect of blood purification combined with mechanical ventilation in the treatment of acute respiratory distress syndrome caused by severe acute pancreatitis and its influence on the incidence of ventilator-associated pneumonia(VAP).Methods 52 patients with acute respiratory distress syndrome caused by severe acute pancreatitis who were admitted to the hospital from May 2019 to June 2021 were conveniently selected and randomly divided into a study group(n=26)and a control group(n=26).The study group was treated with blood purification combined with mechanical ventilation,and the control group was treated with mechanical ventilation.The changes in the levels of inflammatory factors,the changes in related prognostic indicators,the occurrence of VAP and the mortality were compared between the two groups.Results The level of PCT and hs-CRP in the study group was(27.0±9.2)μg/L and(142.2±46.8)mg/L before treatment.In the control group,PCT level was(26.7±8.9)μg/L and hs-CRP level was(138.3±44.2)mg/L before treatment.There was no statistically significant difference in the levels of inflammatory factors between the two groups before treatment(t=0.120,0.309,P>0.05).After treatment,PCT level was(11.3±4.9)μg/L,hs-CRP level was(78.1±35.8)mg/L in the study.In control group,PCT level was(19.1±6.4)μg/L,and hs-CRP level was(103.4±33.7)mg/L.The levels of PCT and hs-CRP in the study group were significantly lower than those in the control group,the difference between the two groups was statistically significant(t=4.934,2.624,P<0.05).In the study group,the total mechanical ventilation duration was(5.0±1.3)d,abdominal distention and abdominal pain symptoms disappeared(3.1±0.3)d,pancreatic edema improved(6.1±1.4)d and hospital stay was(9.5±1.3)d.In the control group,total mechanical ventilation duration was(8.1±2.5)d,abdominal distention and abdominal pain symptom disappeared time was(4.7±0.4)d,pancreatic edema improved time was(7.9±1.8)d and hospital stay was(16.1±2.4)d.The related prognostic indicators in the control group were worse than those in the study group,the difference between the two groups was statistically significant(t=5.609,16.316,4.025,12.331,P<0.05).The incidence and mortality of VAP in the control group were 38.5% and 19.2% higher than those in the study group 11.5%and 3.8%,the difference between the two groups was statistically significant(P<0.05).Conclusion The clinical effect of blood purification combined with mechanical ventilation in the treatment of acute respiratory distress syndrome caused by severe acute pancreatitis is significant,which can effectively improve the patient's condition,reduce inflammation,and reduce the incidence of VAP,which can be promoted in clinical practice.
作者
黄观日
陆俊江
许万群
王昌伟
HUANG Guanri;LU Junjiang;XU Wanqun;WANG Changwei(Department of Critical Care Medicine,Tianhe District People's Hospital,Guangzhou,Guangdong Province,510660 China;Department of Critical Care Medicine,Guangdong Provincial General Hospital of Armed Police Force,Guangzhou,Guangdong Province,510507 China;Emergency Department,Tianhe District People's Hospital,Guangzhou,Guangdong Province,510660 China)
出处
《中外医疗》
2022年第3期21-24,共4页
China & Foreign Medical Treatment
关键词
血液净化
机械通气
重症急性胰腺炎致急性呼吸窘迫综合征
临床效果
VAP发生率
Blood purification
Mechanical ventilation
Acute respiratory distress syndrome due to severe acute pancreatitis
Clinical effect
The incidence of VAP
