目的 探讨特发性间质性肺炎（IIPs）[非特发性肺间质性纤维化（IPF）型]合并弥漫性肺部出血综合征患者治疗方案以及应用价值。方法 报道1例IIPs（非IPF型）合并弥漫性肺部出血综合征患者的治疗经过以及结果,结合文献分析治疗IIPs（非IPF型）合并弥漫性肺部出血综合症临床应用价值。结果 该文报道 l 例特发性肺间质肺炎（非IPF型）伴弥漫性肺泡出血综合征的老年男性患者,合并呼吸、循环衰竭,启用静脉-静脉体外膜肺氧合（VV-ECMO）抢救并成功撤机,病情好转出院。结论 IIPs作为病因以及发病机制未明、临床表现多样的一类肺间质性疾病,需临床多学科协作,及早诊断、治疗,才能成功挽救患者。

Objective To explore the treatment plan and application value of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome．Methods A case of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was reported．The clinical application value of treatment of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was analyzed combined with the literature．Results A case of idiopathic interstitial pneumonia（non IPF type）with diffuse alveolar hemorrhage syndrome was reported in this paper． Combined with respiratory and circulatory failure,veno-venous extracorporeal membrane oxygenation was used to rescue and successfully wean,and the condition improved and discharged．Conclusions Through the curative effect evaluation of this patient,it is believed that idiopathic interstitial pneumonia,as a kind of pulmonary interstitial disease with unknown etiology and pathogenesis and diverse clinical manifestations,need clinical multidisciplinary cooperation,early diagnosis and treatment,in order to successfully save the patient．

目的 探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法 回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组, 每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例, 观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果 2组患者治疗后5~7 d内APACHE Ⅱ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72) vs (11.24±2.76) mmol/L]、血肌酐[(69.51±15.03) vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693, 5.924, 7.440, 9.362, 5.235, 6.801, 5.018,P均＜0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs (5.22±1.51) d]、体征指标稳定时间[(2.52±1.38) vs (4.39±1.50) d]、胃肠功能恢复时间[(4.48±1.27) vs (6.21±1.55) d]以及ICU住院时间[(15.03±2.21) vs (18.44±3.27) d]均低于对照组,结果分析差异有统计学意义(t=5.954, 5.190, 4.884,4.888,P均＜0.05)。结论 与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out. The patients were divided into the observation group and the control group according to different treatment regimens, with 32 cases in each group, and the baseline levels of the two groups were consistent. Patients in the control group were treated with conventional medical treatment, and the patients in the observation group were treated with CRRT on the basis of the control group, and the efficacy of the two groups were analyzed and compared. Results The APACHE II scores [(11.02±3.14) vs (13.98±3.27)]、triglyceride[(4.02±1.05) vs (5.62±1.11) mmol/L], C-reactive protein[(88.25±6.73) vs (104.41±10.28) ng/L], procalcitonin[(13.12±4.33) vs (18.55±3.96) ng/mL], blood urea nitrogen[(7.33±1.72) vs (11.24±2.76) mmol/L], serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L] of patients in both groups were significantly decreased within 5-7 days after treatment compared with those before treatment, and the decrease of the above indicators in the observation group was significantly greater than that in the control group, P<0.05. The remission time of symptoms[(3.15±1.26) vs (5.22±1.51) d], the stabilization time of signs[(2.52±1.38) vs (4.39±1.50) d], the recovery time of gastrointestinal function[(4.48±1.27) vs (6.21±1.55) d] and the length of ICU stay[(15.03±2.21) vs (18.44±3.27) d] in the observation group were lower than those in the control group, and the analysis of the results was statistically significant (t=5.954, 5.190, 4.884,4.888,all P＜0.05). Conclusions Compared with conventional medical treatment, additional CRRT treatment can significantly improve the inflammatory indicators of SAP, help patients survive from critical state of SAP, which has positive clinical value.