Clinical Effect of Noninvasive Positive Pressure Ventilation on Severe Acute Pancreatitis Combined with Acute Lung Injury in Emergency_West China Medical Journal

Authors：

 YangYong ,  LiuJining , LiuDan , LüRuqi

Emergency Department, Central Hospital of Mianyang, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

LiuJining, Email: cqydg@126.com

Keywords：

Emergency treatment; Noninvasive positive pressure ventilation; Severe acute pancreatitis; Acute lung injury; Hospital stay; Mortality

DOI：

10.7507/1002-0179.201600276

Video：

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Objective To analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. Methods Fifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. Results Before treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO₂) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P＜0.05); the PaO₂ value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P＜0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P＜0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). Conclusion It is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.

Citation： YangYong, LiuJining, LiuDan, LüRuqi. Clinical Effect of Noninvasive Positive Pressure Ventilation on Severe Acute Pancreatitis Combined with Acute Lung Injury in Emergency. West China Medical Journal, 2016, 31(6): 1028-1030. doi: 10.7507/1002-0179.201600276 Copy

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2.	Surbatovic M, Jovanovic K, Radakovic S, et al. Pathophysiological aspects of severe acute pancreatitis-associated lung injuryJ[]. Srp Arh Celok Lek, 2005, 133(1/2):76-81.
3.	De Campos T, Deree J, Coimbra R. From acute pancreatitis to end-organ injury: mechanisms of acute lung injury[J]. Surg Infect (Larchmt), 2007, 8(1): 107-120.
4.	劉學民, 潘承恩, 劉青光, 等. 重癥急性胰腺炎胰腺損傷與肺損傷的關系[J]. 西安交通大學學報: 醫學版, 2005, 26(4): 371-373.
5.	彭加英, 李先全, 范紅英. 超早期無創正壓通氣治療重癥急性胰腺炎所致肺損傷療效觀察[J]. 醫學理論與實踐, 2010, 23(5): 502-504.
6.	中華醫學會科學分會胰腺外科學組. 重癥急性胰腺炎診治草案[J]. 中華普通外科雜志, 2001, 16(11): 699-700.
7.	中華醫學會呼吸病學分會. 急性肺損傷/急性呼吸窘迫綜合征的診斷標準(草案) [J]. 中華結核和呼吸雜志, 2000, 23(4): 203.
8.	張海瑛, 臧澤林, 雷霆, 等. 無創正壓通氣對重癥急性胰腺炎合并 ALI/ARDS的治療價值[J]. 西部醫學, 2010, 4(22): 644-645.
9.	尹輝明, 米允仕, 許燕山, 等. 雙水平無創正壓通氣治療重癥急性胰腺炎合并急性肺損傷20例[J]. 中國危重病急救醫學, 2004, 16(12): 763-763.
10.	Imai Y, Kawano T, Miyasaka K, et al. Inflammatory chemical mediators during conventional ventilation and during high frequency oscillatory ventilation[J]. Am J Respir Crit Care Med, 1994, 150(6 Pt 1): 1550-1554.
11.	Takata M, Abe J, Tanaka H, et al. Intraalveolar expression of tumor necrosis factor-alpha gene during conventional and high-frequency ventilation[J]. Am J Respir Crit Care Med, 1997, 156(1): 272-279.
12.	陳新, 陳瑞, 許睿, 等. 無創正壓通氣對急性肺損傷早期氣體交換和呼吸應答的影響[J]. 當代醫學, 2011, 17(31): 1-3.
13.	古滿平, 丁福, 范晶. 無創正壓通氣在多發傷并發ALI/ARDS中的臨床應用[J]. 重慶醫科大學學報, 2010, 35(12): 1884-1887.
14.	熊艷, 袁月華, 洪武軍, 等. 重癥急性胰腺炎并發急性呼吸窘迫綜合征的肺保護通氣[J]. 中國綜合臨床, 2005, 21(3): 239-240.
15.	張魯軍. 無創機械通氣在急性肺損傷治療中的應用[J]. 齊魯護理雜志, 2007, 13(20): 23-24.
16.	吳峰, 楊德春, 蔣田華, 等. 無創通氣治療重癥急性胰腺炎并發 ALI/ARDS療效探討[J]. 中國民康醫學, 2006, 18(22): 846-846.
17.	Yilmaz M, Gajic O. Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome[J]. Eur J Anaesthesiol, 2008, 25(2): 89-96.
18.	余康敏, 王春友, 陳鑫. 中性粒細胞凋亡對急性胰腺炎相關性肺損傷的影響[J]. 中華急診醫學雜志, 2005, 14(9): 742-745.
19.	Hartwig W, Carter EA, Jimenez RE, et al. Neutrophil metabolic activity but not neutrophil sequestration reflects the development of pancreatitis-associated lung injury[J]. Crit Care Med, 2002, 30(9): 2075-2082.
20.	尹輝明, 楊晶, 楊宏亮, 等. 雙水平無創正壓通氣早期治療創傷后急性肺損傷/急性呼吸窘迫綜合征[J]. 中國呼吸與危重監護雜志, 2007, 6(3): 219-220.
21.	劉丹, 周發春, 徐昉. 早期無創正壓機械通氣在治療重癥急性胰腺炎急性肺損傷中的應用價值研究[J]. 重慶醫學, 2009, 38(20): 2528-2529.

1. Ogawa M, Hirota M, Hayakawa T, et al. Development and use of a new staging system for severe acute pancreatitis based on a nationwide survey in Japan[J]. Pancreas, 2002, 25(4): 325-330.
2. Surbatovic M, Jovanovic K, Radakovic S, et al. Pathophysiological aspects of severe acute pancreatitis-associated lung injuryJ[]. Srp Arh Celok Lek, 2005, 133(1/2):76-81.
3. De Campos T, Deree J, Coimbra R. From acute pancreatitis to end-organ injury: mechanisms of acute lung injury[J]. Surg Infect (Larchmt), 2007, 8(1): 107-120.
4. 劉學民, 潘承恩, 劉青光, 等. 重癥急性胰腺炎胰腺損傷與肺損傷的關系[J]. 西安交通大學學報: 醫學版, 2005, 26(4): 371-373.
5. 彭加英, 李先全, 范紅英. 超早期無創正壓通氣治療重癥急性胰腺炎所致肺損傷療效觀察[J]. 醫學理論與實踐, 2010, 23(5): 502-504.
6. 中華醫學會科學分會胰腺外科學組. 重癥急性胰腺炎診治草案[J]. 中華普通外科雜志, 2001, 16(11): 699-700.
7. 中華醫學會呼吸病學分會. 急性肺損傷/急性呼吸窘迫綜合征的診斷標準(草案) [J]. 中華結核和呼吸雜志, 2000, 23(4): 203.
8. 張海瑛, 臧澤林, 雷霆, 等. 無創正壓通氣對重癥急性胰腺炎合并 ALI/ARDS的治療價值[J]. 西部醫學, 2010, 4(22): 644-645.
9. 尹輝明, 米允仕, 許燕山, 等. 雙水平無創正壓通氣治療重癥急性胰腺炎合并急性肺損傷20例[J]. 中國危重病急救醫學, 2004, 16(12): 763-763.
10. Imai Y, Kawano T, Miyasaka K, et al. Inflammatory chemical mediators during conventional ventilation and during high frequency oscillatory ventilation[J]. Am J Respir Crit Care Med, 1994, 150(6 Pt 1): 1550-1554.
11. Takata M, Abe J, Tanaka H, et al. Intraalveolar expression of tumor necrosis factor-alpha gene during conventional and high-frequency ventilation[J]. Am J Respir Crit Care Med, 1997, 156(1): 272-279.
12. 陳新, 陳瑞, 許睿, 等. 無創正壓通氣對急性肺損傷早期氣體交換和呼吸應答的影響[J]. 當代醫學, 2011, 17(31): 1-3.
13. 古滿平, 丁福, 范晶. 無創正壓通氣在多發傷并發ALI/ARDS中的臨床應用[J]. 重慶醫科大學學報, 2010, 35(12): 1884-1887.
14. 熊艷, 袁月華, 洪武軍, 等. 重癥急性胰腺炎并發急性呼吸窘迫綜合征的肺保護通氣[J]. 中國綜合臨床, 2005, 21(3): 239-240.
15. 張魯軍. 無創機械通氣在急性肺損傷治療中的應用[J]. 齊魯護理雜志, 2007, 13(20): 23-24.
16. 吳峰, 楊德春, 蔣田華, 等. 無創通氣治療重癥急性胰腺炎并發 ALI/ARDS療效探討[J]. 中國民康醫學, 2006, 18(22): 846-846.
17. Yilmaz M, Gajic O. Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome[J]. Eur J Anaesthesiol, 2008, 25(2): 89-96.
18. 余康敏, 王春友, 陳鑫. 中性粒細胞凋亡對急性胰腺炎相關性肺損傷的影響[J]. 中華急診醫學雜志, 2005, 14(9): 742-745.
19. Hartwig W, Carter EA, Jimenez RE, et al. Neutrophil metabolic activity but not neutrophil sequestration reflects the development of pancreatitis-associated lung injury[J]. Crit Care Med, 2002, 30(9): 2075-2082.
20. 尹輝明, 楊晶, 楊宏亮, 等. 雙水平無創正壓通氣早期治療創傷后急性肺損傷/急性呼吸窘迫綜合征[J]. 中國呼吸與危重監護雜志, 2007, 6(3): 219-220.
21. 劉丹, 周發春, 徐昉. 早期無創正壓機械通氣在治療重癥急性胰腺炎急性肺損傷中的應用價值研究[J]. 重慶醫學, 2009, 38(20): 2528-2529.

West China Medical Journal

Clinical Effect of Noninvasive Positive Pressure Ventilation on Severe Acute Pancreatitis Combined with Acute Lung Injury in Emergency

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