黄灿霞.10例高甘油三酯血症性急性胰腺炎合并急性呼吸窘迫综合征的呼吸支持特点分析[J].内科急危重症杂志,2023,29(6):465-471
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| DOI：10.11768/nkjwzzzz20230606 |
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| 中文摘要: |
| 摘要 目的：分析10例高甘油三酯血症性急性胰腺炎（HTG-AP）合并急性呼吸窘迫综合征（ARDS）患者的临床特征及呼吸支持治疗方式。方法：选取10例 HTG-AP 合并 ARDS 患者为研究对象，其中单纯使用高流量氧疗(HFNO)4例为HFNO组，使用有创机械通气（IMV）6例为IMV组。比较2组人口学资料、体重指数、呼吸频率、实验室检查、肺部及腹部特征、呼吸支持参数等。结果：IMV组患者中3例入ICU时立即接受IMV，另3例由HFNO或无创呼吸机辅助通气（NIV）失败后转为IMV。10例HTG-AP合并ARDS中男性8例，IMV组中肥胖5例，HNFO组1例；与HFNO组比较，IMV组年龄更小[(36.7±6.3)岁 vs (49.8±10.2)岁，P=0.035]、膀胱压较高[(30.33±6.22)cmH2O vs (23.25±1.5)cmH2O，P=0.038]、呼吸频率明显更快 [(45.67±5.75）次/min vs (34.75±3.69)次/min,P=0.01]。腹部CT均示急性胰周液体积聚，急性坏死物积聚3例（IMV组1例，HFNO组2例）；胰腺假性囊肿2例，均为IMV组；包裹性坏死2例(2组各1例)。胸片或胸部CT均示双肺渗出并双下肺背侧含气不全。呼吸支持治疗：IMV均采用肺保护性通气策略，压力辅助/控制模式，压力支持为10~14cmH2O,目标潮气量控制为6~8mL/kg预测体重（PBW），呼气末正压（PEEP）大部分予以10~14cmH2O；HFNO组患者给予氧流量40~60L/min，吸氧浓度40%~60%。所有患者经治疗后均成功脱机，好转出院。结论：HFNO及IMV是HTG-AP合并ARDS患者有效呼吸支持方式，通常患者合并肥胖、气促明显、腹内高压时，IMV常需予以较高PEEP水平的肺保护性通气。 |
| 英文摘要: |
| Abstract Objective: To analyze the clinical characteristics and respiratory support strategies in 10 patients with hypertriglyceridemic acute pancreatitis (HTG-AP) complicated with acute respiratory distress syndrome (ARDS). Methods: Totally, 10 HTG-AP patients with ARDS were selected as the study objects, and the patients were divided into groups according to the respiratory support methods. There were 4 patients receiving high-flow nasal oxygen (HFNO) alone, and 6 subjects undergoing invasive mechanical ventilation (IMV), and were categorized into the HFNO group and IMV group, respectively. Demographic data, body mass index, respiratory rate, laboratory examination, lung and abdominal characteristics, respiratory support parameters were compared between the two groups. Results: In the IMV group, 3 patients received invasive mechanical ventilation immediately upon ICU admission, and the remaining 3 patients initially received HFNO or noninvasive ventilation (NIV) but failed and transitioned to IMV. Most of the HTG-AP with ARDS cases were male (8 cases), and the IMV group had 5 cases of obesity, while the HFNO group had 1 case of obesity. The IMV group had a younger age [(36.67±6.28) years vs (49.75±10.21)years, P=0.035], higher bladder pressure [(30.33±6.22)cmH2O vs (23.25±1.5)cmH2O, P=0.038], and significantly quicker respiratory rate [(45.67±5.75)beats/min vs (34.75±3.69)beats/min, P=0.01] than the HFNO group. Abdominal CT scans showed fluid accumulation in the acute pancreatic area in all cases, acute necrotic material accumulation occurred in 3 cases (1 in the IMV group, 2 in the HFNO group), while 2 cases of pseudocysts were identified in the IMV group, and encasement necrosis was observed in 2 cases (1 each in the IMV and HFNO group). Chest X-rays or CT scans indicated bilateral lung infiltrates with incomplete aeration in the dorsal aspect of the lower lungs. Respiratory support treatment included lung-protective ventilation strategies for all patients receiving IMV, using pressure assist/control ventilation mode, with pressure support ranging from 10-14cmH2O and targeted tidal volume control of 6-8mL/kg predicted body weight (PBW). The HFNO group received flow rates of 40-60L/min with an oxygen concentration of 40%-60%. All patients successfully weaned off from respiratory support and showed improvement upon discharge. Conclusion: HFNO and IMV are effective respiratory support approaches for HTG-AP complicated with ARDS. With the patient commonly associated with obesity, significant dyspnea, and elevated intra-abdominal hypertension, IMV requires a lung-protective ventilation strategy with higher PEEP levels. |
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