高水平呼气末正压通气与标准呼气末正压通气对重症急性胰腺炎伴急性呼吸窘迫综合征的不同疗效

摘要

目的研究高水平呼气末正压通气（positive end-expiratory pressure，PEEP）与标准PEEP对重症急性胰腺炎（severe acute pancreatitis，SAP）伴急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）的疗效。方法选取本院重症医学科2015年1月至2015年12月收治的60例SAP伴ARDS患者为研究对象。按给予的PEEP水平不同将入选患者分为观察组（高水平PEEP＞15 cmH2O，35例）与对照组（标准PEEP＜10 cmH2O，25例）。比较两组患者治疗前后急性生理和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、机械通气时间、入住ICU时间、ICU死亡率及出院后90天死亡率。结果两组患者治疗后APACHEⅡ评分均显著低于治疗前（P＜0.01），观察组患者治疗后APACHEⅡ评分显著低于对照组（P＜0.01）。观察组患者机械通气时间与入住ICU时间均显著短于对照组（P＜0.01）。两组患者入住ICU期间均未出现死亡病例。出院后90天，观察组患者死亡1例（2.86%），对照组死亡3例（12.00%），且均死于多脏器功能衰竭，两组比较差异无显著性（χ2＝0.765， P＞0.05）。结论高水平PEEP可明显改善SAP伴ARDS患者病情，缩短通气时间和入住ICU时间，提高治疗效果，但对死亡率的影响不显著。%Objective To investigate the clinical efficacy of high and standard levels of positive end-expiratory pressure (PEEP) in the treatment of severe acute pancreatitis (SAP) patients with acute respiratory distress syndrome (ARDS). Method 60 cases of SAP patients with ARDS who were treated in our hospital from January 2015 to December 2015 were selected as research objects. Based on their PEEP levels, all patients were divided into two groups:observation group (PEEP>15 cmH2O, n=35) and control group (PEEP<10 cmH2O, n=25). The APACHE Ⅱscores before and after treatment, mechanical ventilation time, ICU stay, ICU mortality, and 90-day mortality after discharge from hospital between the two groups were compared and analyzed. Result The scores of APACHEⅡafter treatment of the two groups were significantly lower than before treatment (P<0.01), the APACHEⅡscore of observation group was significantly lower than control group (P<0.01). The mechanical ventilation time and ICU stay in observation group were significantly shorter than control group (P < 0.01). There were no deaths in the two groups during the period of ICU. On the 90 days after discharge, 1 case (2.86%) of patient was died in observation group, 3 cases of patients were died (12%) in control group, and all of the patients died of multiple organ failure. There was no significant differencein mortality between the two groups at 90 days after discharge (χ2 = 0.765, P > 0.05). Conclusion The high level of PEEP can significantly alleviate the symptoms of SAP patients with ARDS, shorten mechanical ventilation time and ICU stay, and improve the treatment efficiency. However, its influence on mortality of the patients is not so obvious.