体质量指数对重症急性胰腺炎并ARDS患者治疗效果及预后的影响

摘要

目的 探讨体质量指数(BMI)对重症急性胰腺炎(SAP)并急性呼吸窘迫综合征(ARDS)患者治疗效果及预后的影响.方法 选择ICU收治发病时间<24 h的SAP并ARDS患者106例,均按照最新治疗指南给予标准化治疗,并依据BMI将患者分为体质量正常组41例、超重组34例和肥胖组31例.治疗前对三组进行急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)及急性胰腺炎Rasnon评分;治疗前、治疗72 h检测三组血白细胞(WBC)、C反应蛋白(CRP)、淀粉酶(AMY)、尿素氮(BUN)、肌酐(Cr)、血乳酸(Lac)、腹内压(IAP)、氧合指数(PaO2/FIO2)、呼气末正压(PEEP)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI),记录72 h液体总量、机械通气时间及28 d病死率.结果 与肥胖组比较,体质量正常组治疗后72 h血WBC、CRP、AMY、BUN、Cr、LAC、IAP、PaO2/FIO2、PEEP、EVLWI、PVPI差异均有统计学意义(P均<0.05);与肥胖组比较,超重组治疗后72 h除血WBC、CRP、LAC、PaO2/FIO2、PEEP外,其余各项指标差异均有统计学意义(P均<0.05).与肥胖组比较,体质量正常组、超重组72 h液体总量少,机械通气时间短,差异有统计学意义(P均<0.05).不同BMI组间28 d病死率差异无统计学意义(P均>0.05).二分类Logistic回归分析显示BMI是SAP并ARDS患者的预后影响因素.结论 BMI可影响SAP并ARDS患者的的治疗效果及预后.%Objective To explore the impact of (BMI)on the therapeutic effect and prognosis of patients with severe acute pancreatitis (SAP)and acute respiratory distress syndrome (ARDS). Methods Totally 106 patients with SAP and ARDS,admitted in the intensive care unit (ICU)with the duration < 24 h were selected. Each patient was treated with standard therapies according to the latest guide of SAP. According to BMI,the patients were divided into BMI normal group (n = 41),overweight group (n = 34),and obese group (n = 31). Acute physiology and chronic health evaluation systemⅡ (APACHE Ⅱ)and acute pancreatitis Rasnon were scored before treatment in the three groups. The white blood cell (WBC),C-reactive protein (CRP),amylase (AMY),urea nitrogen (BUN),creatinine (Cr),blood lactic acid (Lac), and intra-abdominal pressure (IAP),PaO2 / FIO2,PEEP,extravascular lung water index (EVLWI),and pulmonary vas-cular permeability index (PVPI)were measured before and after treatment for 72 h. The volume fluid at 72 h,duration of mechanical ventilation and 28-day mortality were recorded. Results Significant differences were found in the blood WBC, CRP,AMY,BUN,Cr,LAC,IAP,PaO2 / FIO2,PEEP,EVLWI,and PVPI after treatment of 72 h between the control group and BMI normal group (all P < 0. 05). Compared with the obese group,except WBC,CRP,LAC,PaO 2 / FIO2 ,and PEEP,the improvement of the other indexes in the overweight group after treatment of 72 h was statistically significant (all P < 0. 05). Compared with the obese group,the volume fluid at 72 h and the duration of mechanical ventilation were less in the BMI normal and overweight groups,there was statistically significant differences (both P < 0. 05). No significant differ-ence was found in the 28-day mortality between these three groups (P > 0. 05). Binary logistic regression analysis showed that BMI was the prognostic factor for patients with SAP and ARDS. Conclusions BMI may have some influence on the therapeutic effect and prognosis of patients with SAP and ARDS.