摘要
目的探讨重症急性胰腺炎（SAP）早期液体量对患者预后的影响。方法采用回顾性队列研究设计，收集笔者医院2007年8月～2013年6月同期入院的50例SAP患者，根据患者第1个24h接受的液体不同分为两组。A组：〈6．0L和B组：〉6．0L，其他治疗方法不变。然后统计其住院时间、人住ICU时间、机械通气情况、每24h的总液体入量、APACHEⅡ评分、HCT、HR、血压和脉搏。计算患者机械通气情况、并发症的发生率、病死率和治愈率。结果B组较A组第1个24h液体量（6516．2±441．8 vs 3746．5±992．4ml）、72h总液体量（14577．2±1711．2 vs 13807．9±2639．3ml）及72h总尿量（8112．2±2167．6 vs 4489．1±903．8ml）增加（P〈0．05），但72h正平衡液体量（6465．1±3451．9 vs 8598．8±2880．3ml）、第2个24h液体量（3945．6±915．0 vs 4556．9±1121．7ml）、第3个24h液体量（4115．4±870．7 vs 4784．5±1025．6ml）反而减少（P〈0．05）。虽然两组都达到了液体复苏目标，但72h后A组较B组APACHEⅡ评分（12．67±3．98 vs 8．10±2．61分）更高（P〈0．05），住院时间（36．30±22．65 vs 20．85±11．90天）、ICU时间（1．65±5．50 vs 7．20±12．08天）更长（P〈0．05），呼吸功能不全发生率（18％vs6％）、假性囊肿发生率（17％vs4％）、病死率（7％vs0）更高（P〈0．05）。此外，在机械通气发生率（10％vs2％）和机械通气时间（4．73±8．85vs1．40±4．87天）方面未见明显差异（P〉0．05）。结论对于重症急性胰腺炎，推荐应在24h内给予不少于6L的液体。
Objective To study the influence of early fluid resuscitation on the outcome of patients admitted to the hospital with se- vere acute pancreatitis （SAP）. Methods The data of 50 patients admitted to our hospital with severe acute pancreatitis （SAP） from Au- gust 2007 -June 2013 were analyzed retrospectively. Patients were divided into two groups according to resuscitation fluid amount in the first 24h of admission. Group A received 〈 6.0L, and Group B received 〉 6. 0L, and other treatment remained the same. The primary out- comes were duration of hospitalization, duration of ICU, conditions of mechanical ventilation, total amount of fluid administered per 24h after admission, the APACHE Ⅱ score per 24h, HCT per 24h, Mean HR per 24h, Mean blood pressure per 24h and pulse per 24h. And then the frequency of complications and death were measured. Results Compared to group A,group B had a greater fluid amount in the first 24h after admission （6516.2± 441.8 vs 3746.5 ± 992.4ml, P 〈 0.05 ） , in the 72h after admission （ 14577.2 ±1711.2 vs 13807.9 ±2639.3ml, P 〈 0.05 ）. And so did total urine output in the 72h after admission （ 8112.2 ± 2167.6 vs 4489.1 ± 903.8ml, P 〈 0.05 ）. How- ever, unlike group A, in the 72h after admission positive - balance of fluid amount （6465.1 ± 3451.9 vs 8598.8 ± 2880.3ml） , in the sec- ond 24h after admission of fluid amount（ 3945.6± 915.0 vs 4556.9 ±1121.7ml） ,in the third 24h after admission of fluid amount（4115.4 ± 870.7 vs 4784.5 ± 1025.6ml） group B had decreased（ P 〈 0.05 ）. Although both groups reached the goal of early fluid resuscitation, in the 72h after admission, group A comparing to group B in the APACHE Ⅱ score（ 12.67 ± 3.98 vs 8.10 ±2.61 ） were higher, in the dura- tion of hospitalization （ 36.30 ± 22.65 vs 20.85 ± 11.90d） and in the duration of ICU （ 1.65 ±5.50 vs 7.20 ±12.08 d） were longer, in the incidence of respiratory insufficiency （ 18% vs 6% ） and in the incidence of pseudocyst （ 17% vs 4% ） and death（7% vs 0） were higher （P 〈 0.05）. In addition, the incidence of mechanical ventilation （10% vs 2% ） and mechanical ventilation time （4.73 ± 8.85 vs 1.40± 4. 87d） had not significant differences（ P 〉 0.05）. Conclusion For severe acute panereatitis, it should be given not less than 6L fluid in the first 24h after admission by our recommended.
出处
《医学研究杂志》
2014年第1期78-81,共4页
Journal of Medical Research
关键词
重症急性胰腺炎
早期液体复苏
大剂量的液体复苏
Severe acute pancreatitis
Early fluid resuscitation
Aggressive fluid resuscitation
作者简介
通讯作者：潘景业，电子信箱：panjingye@wzhospital．cn
