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目的:探讨机械通气联合血液滤过治疗重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)的疗效。方法:选取2014年3月至2016年3月本院收治的60例SAP致ARDS患者,按随机数字法分为观察组30例,在药物和机械通气的基础上,联合血液滤过治疗。对照组30例,仅采用药物加机械通气治疗。对比两组患者在机械通气、重症监护室(ICU)住院时间和氧合参数变化等方面的疗效,以及呼吸机相关性肺部感染(VAP)发生率和28 d死亡率等预后指标。结果:观察组的总机械通气时间、有创通气时间、ICU住院时间均优于对照组(P<0.05)。两组患者治疗前的氧合指数(Pa O2/Fi O2)、动脉血二氧化碳分压(Pa CO2)、肺泡氧分压(Pa O2)比较,差异无统计学意义(P>0.05);观察组治疗5 d后的Pa O2/Fi O2、Pa O2数值均高于对照组(P<0.05),且Pa CO2数值低于对照组(P<0.05)。观察组VAP发生率、死亡率均低于对照组(P<0.05)。结论:对SAP合并ARDS患者应用机械通气联合血液滤过治疗可改善氧合通气、减少机械通气和ICU住院时间,最终减少VAP发生率和28 d死亡率从而改善预后。
Objective: To investigate the effect of mechanical ventilation combined with hemofiltration in the treatment of severe acute pancreatitis (SAP) combined with acute respiratory distress syndrome (ARDS). Methods: From March 2014 to March 2016, 60 patients with SAP-induced ARDS in our hospital were selected and divided into observation group (n = 30) by random number method and combined with hemofiltration treatment on the basis of drug and mechanical ventilation. Control group, 30 cases, only the use of drugs plus mechanical ventilation. The curative effect of mechanical ventilation, intensive care unit (ICU) hospital stay and changes of oxygenation parameters were compared between the two groups. Prognostic indicators such as ventilator-associated lung infection (VAP) and 28-day mortality were compared. Results: The total mechanical ventilation time, invasive ventilation time and hospital stay time in the observation group were better than those in the control group (P <0.05). The PaO2 / Fi O2, Pa CO2 and Pa O2 of the two groups before treatment were not significantly different (P> 0.05). The observation group The values of Pa O2 / Fi O2 and Pa O2 after 5 days of treatment were higher than those of the control group (P <0.05), and the values of Pa CO2 were lower than those of the control group (P <0.05). The observation group VAP incidence and mortality were lower than the control group (P <0.05). Conclusion: The use of mechanical ventilation combined with hemofiltration in SAP patients with ARDS can improve oxygenation ventilation, reduce mechanical ventilation and ICU hospital stay, and ultimately reduce the incidence of VAP and 28-day mortality to improve prognosis.