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目的探讨地塞米松对重症急性胰腺炎(SAP)并发急性肺损伤(ALI)的防治作用。方法将134例SAP早期出现低氧血症病人随机分为实验组及对照组,实验组一旦发生低氧血症即予地塞米松针剂10mg每天1次静脉注射,持续3～5d。2组其他治疗相同。观察2组病人低氧血症持续时间、ALI及急性呼吸窘迫综合征(ARDS)发生率、机械通气使用率与持续时间以及死亡例数、住院时间。结果实验组及对照组机械通气使用率分别为3.7%(2/54)、16.3%(13/80),机械通气时间分别为(4.5±1.5)d、(6.4±4.4)d,低氧血症持续时间分别为(7.4±3.2)d、(12.1±6.7)d,差异均有统计学意义(P均<0.05);2组住院天数分别为(14.3±11.2)d、(18.7±15.1)d,差异有统计学意义(P<0.05);ALI及ARDS发生率、死亡发生率2组差异无统计学意义(P>0.05)。结论SAP并发低氧血症患者早期使用地塞米松,可降低其机械通气使用几率及减少机械通气时间,并能缩短患者住院时间,对SAP并发ALI具有一定防治作用。
Objective To investigate the preventive and therapeutic effects of dexamethasone on acute lung injury (ALI) in patients with severe acute pancreatitis (SAP). Methods A total of 134 SAP patients with early hypoxemia were randomly divided into experimental group and control group. Once hypoxemia occurred in the experimental group, dexamethasone injection 10mg intravenously once daily for 3 ~ 5 days. The other 2 groups were the same. The duration of hypoxemia, the incidence of ALI and acute respiratory distress syndrome (ARDS), the rate of use and duration of mechanical ventilation, the number of deaths and the length of hospital stay were observed in two groups. Results The rates of mechanical ventilation in experimental group and control group were 3.7% (2/54) and 16.3% (13/80), respectively. The durations of mechanical ventilation were (4.5 ± 1.5) days and (6.4 ± 4.4) days respectively. (7.4 ± 3.2) d and (12.1 ± 6.7) d, respectively (all P <0.05). The length of hospital stay in the two groups were (14.3 ± 11.2) days and (18.7 ± 15.1) days, respectively d, the difference was statistically significant (P <0.05); ALI and ARDS incidence, the incidence of death was no significant difference between the two groups (P> 0.05). Conclusions Early use of dexamethasone in patients with SAP complicated with hypoxemia can reduce the chance of mechanical ventilation and reduce the duration of mechanical ventilation and shorten the length of stay in patients with SAP.