首都医科大学学报 ›› 2003, Vol. 24 ›› Issue (2): 155-157.

• 论著·临床研究 • 上一篇    下一篇

重症急性胰腺炎并发急性呼吸窘迫综合征的临床特点与治疗探讨

林栋栋, 李非, 孙家邦, 刘大川, 朱斌   

  1. 首都医科大学宣武医院普外科
  • 收稿日期:2003-01-10 修回日期:1900-01-01 出版日期:2003-04-15 发布日期:2003-04-15

Clinical Features and Management of Acute Respiratory Distress Syndrome in Patients with Severe Acute Pancreatitis

Lin Dongdong, Li Fei, Sun Jiabang, Liu Dachuan, Zhu Bin   

  1. Department of General Surgery, Xuanwu Hospital, Capital University of Medical Sciences
  • Received:2003-01-10 Revised:1900-01-01 Online:2003-04-15 Published:2003-04-15

摘要: 为探讨重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)的临床特点及治疗方法,回顾性分析我院SAP患者246例。总结SAP并发ARDS患者的发生率、发生时间、临床表现、血气变化、X线胸片以及治疗和预后情况,并将SAP患者分为ARDS组和无ARDS组进行比较。结果:SAP并发ARDS的发生率为27.6%,73.5%发生于SAP发病3d内或术后3d内;SAP并发ARDS的临床特点是:发生时间早,起病急,主要表现为呼吸频率增加[(36.76±0.92)次/min],部分患者(39.7%)表现为典型的呼吸窘迫;血气分析提示酸碱失衡以呼吸性碱中毒和呼吸性碱中毒合并代谢性酸中毒多见(89.7%)。高三酰甘油血症、高APACHE-Ⅱ评分、腹腔高压征、手术是ARDS的易患因素。积极处理高三酰甘油血症、腹腔高压征,严格掌握手术指征,合理应用呼吸机可能对SAP并发ARDS患者治疗有效。

关键词: 胰腺炎, 呼吸窘迫综合征, 治疗

Abstract: To explore the clinical features and management of acute respiratory distress syndrome (ARDS) in patients with severe acute pancreatitis (SAP), clinical data of 246 patients with SAPwere reviewed retrospectively in our hospital between 1990 and 2001. The data of occurrence time, respiratory conditions, arterial blood-gas analysis and chest film from 68 patients with ARDS were analyzed. Meanwhile comparisons between patients with ARDS and patients without ARDS were made. The incidence rate of ARDS in patients with SAP was 27.6% . The main features of these patients included early occurrence (73.5% occurred during the first 3 days of SAP or 3 days after operation), increasing respiratory rate (36. 76±0.92/min), respiratory distress(39.7%), respiratory alkalosis and respiratory alkalosis complicated with metabolic acidosis(89.7%). The main factors predisposing to ARDS in patients with SAP were increased serum triglyceride level, higher APACHE-Ⅱscore, intra-abdominal hypertension and operation. Decreasing serum triglyceride level, relieving intra-abdominal hypertension, strictly controlling for operation and applying ventilator timely and properly may be helpful to the prevention and treatment of ARDS in patients with SAP.

Key words: pancreatitis, respiratory distress syndrome, therapy

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