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

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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
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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

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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。

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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.

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在线发布日期: 2018-11-21

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