重症急性胰腺炎并发急性呼吸窘迫综合征的临床治疗

目的探讨重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)患者的临床治疗。方法收集我院2014年1月1日至2015年12月31日2年间首诊或发病48 h内入住ICU的20例重症急性胰腺炎并发ARDS患者的临床资料,以患者脱离呼吸机为观察终点,对其治疗方案及效果进行回顾性分析。结果 20例患者中,除1例因重度ARDS经治疗无好转出院外,其余患者取得良好治疗效果,并脱机拔管成功。结论重症急性胰腺炎并发ARDS患者早期采用有效液体复苏、肺保护性通气、早期液体负平衡、小剂量激素、俯卧位通气、早期肠内营养等措施,能有效治疗重症急性胰腺炎早期并发的ARDS,帮助患者渡过急性期;早期液体复苏具有关键作用,可以改善组织患者氧合和微循环灌注,以维护胰、肾脏和心脏灌注。     

大黄对急性呼吸窘迫综合征综合救治的影响

目的 探讨大黄对急性呼吸窘迫综合征(ARDS) 综合救治的影响.方法 选择ARDS患者60例,随机分成两组,对照组20例给予常规综合治疗,治疗组40例在常规综合治疗的基础上,加用大黄经胃管鼻饲.观察两组病人治疗前后血液中的IL- 6、IL- 8 浓度和动脉血气分析.结果 大黄治疗组7天后患者血液中IL- 6、IL-8 浓度、动脉血气分析较对照组均明显改善(P＜0.05或P＜0.01);而对照组虽然动脉血气结果较治疗前有明显改善(P<0.05或P＜0.01),但该组病人血清炎症介质浓度改变不明显(P＞0.05);大黄治疗组患者的住院时间和死亡率与对照组比较差异均有显著性(P<0.05或P＜0.01).结论 大黄在一定程度上抑制炎症介质的释放,降低死亡率,减少患者住院时间,有利于ARDS患者呼吸功能的恢复.     

急性呼吸窘迫综合征在重症急性胰腺炎治疗过程中的临床意义

目的 探讨急性呼吸窘迫综合征（ARDS）在重症急性胰腺炎（SAP）治疗过程中的临床意义.方法 回顾性分析2003年7月至2006年7月收治的76例SAP患者的临床特点、病程演变趋势和治疗效果,其中29例合并ARDS,经有效呼吸支持,病人情况不稳定,脏器功能无好转.及时行外科手术干预治疗.结果 76例SAP存活64例,死亡12例,存活率84.21%;SAP病程中合并ARDS 29例,存活21例,死亡8例,存活率72.41%,其中手术干预15例,存活10例,死亡5例,存活率66.67%.结论 正确认识和处理SAP病程中并发ARDS,合理选择外科干预方式,对于决定SAP预后至关重要.     

急性呼吸窘迫综合征的机械通气

机械通气是急性呼吸窘迫综合征（ＡＲＤＳ）的关键性治疗措施,然而,尽管设备更新换代,ＡＲＤＳ的死亡率仍高达５０％～７０％。近１０年来,有关ＡＲＤＳ病理改变和呼吸力学的研究进展,尤其是对通气机所致肺损伤（ＶＩＬＩ）的认识深入,促进了ＡＲＤＳ通气目标和策略...     

成人型呼吸窘迫综合征

成人型呼吸窘迫综合征(ARDS)为呼吸急症。凡是能造成肺弥慢性损伤,影响肺泡毛细血管通透性者,皆可成为ARDS的病因。包括:①任何原因的休克。②严重感染:如重症肺炎、革兰氏阴性杆菌败血症及弥漫性腹膜炎等。③严重创伤:如胸、腹外伤、多发骨折及严重烧伤。④吸入毒素:如吸入较长时间高浓度氧及腐蚀性物质氯气、光气、烟雾等。⑤血液系统疾病:如播散性血管内凝血,大量输血、输液等。⑥代谢性疾病:如糖尿病、尿毒     

急性呼吸窘迫综合征31例治疗体会

急性呼吸窘迫综合征 (ＡＲＤＳ)病情凶险 ,病死率较高。近年来 ,我院收治ＡＲＤＳ患者 31例。现报告如下。临床资料 :本组 31例患者均符合中华医学会呼吸病学分会 2 0 0 0年ＡＲＤＳ诊断标准 ,男 2 3例 ,女 8例 ,年龄 1 2～ 66岁。感染性休克 1 0例 ,洗胃液误吸 8例 ,颅脑外伤 7例 ,多发骨折 4例 ,溺水 2例。患者均有呼吸窘迫 ,ＰａＯ2 /ＦｉＯ2 ≤2 0 0ｍｍＨｇ ,ＰａＣＯ2 <35ｍｍＨｇ 2 4例。 31例患者行气管插管 6例 ,气管切开 2 5例。治疗方法 :①全部病例均行动脉血气、经皮血氧饱和度(ＳｐＯ2 )呼吸功能及心电图监测 ;②积极治疗原发…     

流行性出血热并发成人呼吸窘迫综合征的治疗

我院自1985—09／1993—12共收治流行性出血热(EHF)816例，并发急性呼吸窘迫综合征(ARDS)死亡7例，占0．85％。现报告如下。     

控制性肺膨胀治疗急性呼吸窘迫综合征的临床意义

控制性肺膨胀是一种增加肺容积、促进塌陷肺泡复张的方法。在机械通气治疗ＡＲＤＳ时应有管一方法能提高患者肺顺应性,改善氧合,减少气压伤产生,具有重要的临床意义。     

急性胰腺炎合并急性呼吸窘迫综合征一例

患者,女性,42岁。因“腹痛8小时”入院。患者于2011年7月24日晨突发腹痛,以双侧下腹部为主,呈持续性,疼痛性质描述不清,无阵发性加剧,不向其他部位放射。伴有恶心,无呕吐,解黄色稀便1次,便后疼痛没有减轻,无黏液血便。     

急性呼吸窘迫综合征的纤维组织增生

本文概括介绍了临床中晚期急性呼吸综合征的临床和病理特点，主要为急性弥漫性肺泡上皮和毛细血管内皮细胞损伤，继之发生广泛的肺纤维化并引致严重后果。     

大剂量甲泼尼龙治疗急性呼吸窘迫综合征的时机

目的 探讨急性呼吸窘迫综合征(ARDS)综合救治中使用大剂量甲泼尼龙的时机评估.方法 收集对比2008至2011年入院且据其肺顺应性等评估后诊断为晚期ARDS的患者在使用及未使用大剂量甲泼尼龙治疗后的临床数据.结果 28例患者(实验组12例,对照组16例)诊断为晚期ARDS,其各参数基线水平一致.经治疗后,实验组各指标恢复速度比对照组快,但两组死亡率无差别.实验组感染致死率较对照组高.实验组痊愈与死亡者在年龄等方面有差异.结论 肺顺应性等可用于评估晚期ARDS病人开始大剂量甲泼尼龙治疗的时机.病人的年龄、基础病情等可作为疗效预测因子.     

体外膜肺氧合治疗ARDS的实验研究

目的：探讨体外膜肺氧合（ECMO）治疗ARDS的有效性和可行性。方法：采用油酸注入法制备犬ARDS模型,将15只犬随机分为3组：对照组（n=5）、模型组（n=5）及V-VECMO治疗组,通过监测血气指标、血流动力学指标、血管外肺水含量及肺顺应性指标,评价V-VECMO疗效。结果：V-VECMO明显提高了动脉和混合静脉血氧分压,增加氧供,增加心排血量,降低肺血管阻力,减轻肺水肿,肺功能明显改善。结论：ECMO治疗ARDS有效和可行,为临床治疗ARDS提供了新思路。     

Alcohol Abuse Enhances Pulmonary Edema in Acute Respiratory Distress Syndrome

Background:  Pulmonary edema is a cardinal feature of the life-threatening condition known as acute respiratory distress syndrome (ARDS). Patients with chronic alcohol abuse are known to be at increased risk of developing and dying from ARDS. Based upon preclinical data, we hypothesized that a history of chronic alcohol abuse in ARDS patients is associated with greater quantities and slower resolution of pulmonary edema compared with ARDS patients without a history of alcohol abuse.
Methods:  A PiCCO™ transpulmonary thermodilution catheter was inserted into 35 patients within 72 hours of meeting American European Consensus Criteria definition of ARDS. Pulmonary edema was quantified as extravascular lung water (EVLW) and measured for up to 7 days in 13 patients with a history of chronic alcohol abuse and 22 patients without a history of chronic alcohol abuse.
Results:  Mean EVLW was higher in patients with a history of chronic alcohol abuse (16.6 vs. 10.5 ml/kg, p  < 0.0001). Patients with alcohol abuse had significantly greater EVLW over the duration of the study (RM-ANOVA p  = 0.003). There was a trend towards slower resolution of EVLW in patients with a history of alcohol abuse (a decrease of 0.5 ml/kg vs. 2.4 ml/kg, p  = 0.17) over the study period. A history of alcohol abuse conferred a greater than 3-fold increased risk of elevated EVLW [OR 3.16, (1.26 to 7.93)] using multivariate logistic regression analysis.
Conclusions:  In patients who develop ARDS, alcohol abuse is associated with greater levels EVLW and a trend towards slower resolution of EVLW. Combined with mechanistic and preclinical evidence linking chronic alcohol consumption and ARDS, targeted therapies should be developed for these patients.     

Therapeutic Plasma Exchange in Patients with Chylomicronemia Syndrome Complicated by Acute Pancreatitis

Chylomicronemia syndrome (CMS) is a rare disorder characterized by the presence of chylomicrons in the fasting state causing a milky appearance of plasma, eruptive xanthomas, and hepatosplenomegaly; an acute and potentially life threatening complication is severe acute pancreatitis. The underlying defects are inborn errors of metabolism such as deficiencies of lipoprotein lipase (LPL) or apoprotein C-II (apo C-II) as well as familial hypertriglyceridemia. Moreover, CMS can be precipitated when mild hypertriglyceridemia is exacerbated by additional factors such diabetes mellitus, ethanol abuse, or pregnancy. The purpose of the present study was to retrospectively analyze the results of therapeutic plasma exchange (TPE) in 5 patients transferred to our hospital for severe acute pancreatitis due to chylomicronemia syndrome. In a total of 7 TPE sessions, on average 3,286 ± 247 ml of plasma (i.e., about 1 patient plasma volume) were treated per session. Triglyceride (TG) levels were decreased from 4,972 ± 2,469 mg/dl on admission to 1,614 ± 1,276 mg/dl (?70%) after the TPE sessions, and a further decrease was achieved by conservative treatment. Part of the TG reducing effect of the treatment was probably due to heparin induced lipolysis. Acute pancreatitis was resolved in all cases, and 1 pregnant patient delivered without problems at term. In summary, 1 or 2 TPE sessions sufficed to substantially decrease the bulk of triglycerides in acutely exacerbated chylomicronemia syndrome causing a rapid resolution of acute severe pancreatitis.     

肠道菌群及其代谢产物在重症急性胰腺炎相关急性呼吸窘迫综合征中的作用

急性呼吸窘迫综合征(ARDS)是重症急性胰腺炎(SAP)常见的并发症,也是导致SAP患者早期死亡的首要原因,目前发病机制尚不清楚。近年来肠道菌群及其代谢产物参与调控SAP相关ARDS日益受到关注,深入探究“肠-肺轴”的发病机制有助于为SAP-ARDS的药物研发提供新的思路。总结了近年来肠道菌群及其代谢产物在SAP-ARDS领域的研究进展。     

Pulmonary Superinfection by Trichomonads in the Course of Acute Respiratory Distress Syndrome

The finding of trichomonads in bronchoalveolar lavage fluid (BALF) samples from an acute respiratory distress syndrome (ARDS) patient, never previously reported, incited us to search for these parasites retrospectively in the BALF of patients with ARDS or related pathologies. Eighty-four consecutive BALF samples have been reviewed. Results were compared with data from clinical files of patients included in this study. Detection and identification of trichomonads were based on cytologic characteristics. Subsequently, immunocytochemistry and in situ hybridization were performed in the last case of the series. Our results were as follows: (1) Trichomonads were detected in 25/84 BALFs (20/77 patients). Among the patients testing positive, 17 suffered from ARDS, about 30% of the ARDS patients included in the study. (2) Trichomonads were detected more frequently at a late ARDS stage. (3) No correlation was found between trichomonad detection and other data. (4) Within the group of trichomonad-infected ARDS patients, density of infection correlated with higher mortality. The late detection of these microorganisms in the course of ARDS suggested that trichomonad development is a secondary event. As BALFs obtained early in the course of ARDS were also included in the study, trichomonad incidence could be underestimated. The significance of trichomonad lung colonization in ARDS and its potential pathogenic role are unclear. Nevertheless, the question of an active role of trichomonads in the extension of alveolar lesions or in the limitation of recovery is clearly raised.     

重症急性胰腺炎的早期识别和处理

重症急性胰腺炎（SAP）起病急骤,死亡率较高。早期识别SAP并及时处理,有助于降低其死亡率。通过仔细观察患者的临床表现、影像学检查和实验室多项指标检测等有助于及时、正确判断疾病的严重程度。本文就此作一概括,旨在为临床医师诊治SAP提供帮助。     

Acute Pancreatitis Caused by Severe Legionella pneumophila Infection

Summary We report three cases of severe community-acquired Legionella pneumophila with acute pancreatitis. Pancreas involvement is unusual. The clinical presentations consisted of painless pancreatitis with only elevation of serum pancreatic enzymes (case 1), tender abdomen with edematous pancreas on computed tomography scan (case 2) and necrosis (case 3). We discuss the possible mechanisms of L. pneumophila associated acute pancreatitis for which the pathophysiology is still undertermined: infection, toxin release or cytokine secretion. Received: February 11, 2000 · Revision accepted: July 24, 2000