静脉注射6%羟乙基淀粉130/0.4和呋噻米对急性胰腺炎的扩容效果观察  

The volume-expanding effect of 6% hydroxyethylstarch 130/0.4(Voluven) and furosemide in the treatment of acute pancreatitis

作　　者：李依[1] 陈友岱[1] 董芸[1] 胡卫建[1] 周平[1] 王建东[1] 冯卢[1] 邓磊[1] 陈锋[1] 李俊英[1] 

机构地区：[1]四川省医学科学院.四川省人民医院急救中心,四川成都610072

出　　处：《实用医院临床杂志》2010年第1期91-93,共3页Practical Journal of Clinical Medicine

摘　　要：目的观察静脉输注6%羟乙基淀粉130/0.4(万汶)和静脉推注呋噻米(速尿)对急性胰腺炎转归的影响。方法116例急性胰腺炎患者入院当日即给予6%羟乙基淀粉130/0.4静脉输注(成人通常为1000～2000ml),次日开始逐渐减少其用量;在输注6%羟乙基淀粉130/0.4的同时静脉推注呋噻米,力求作到出入量基本平衡。结果应用6%羟乙基淀粉和呋噻米1～3天后,血容量恢复正常;99例患者痊愈后的血细胞压积(Hct)为33.6±5.7,显著低于入院时的41.6±6.9(t=13.359,P<0.05);血浆白蛋白浓度为(33.2±7.8)g/L,与入院时(36.3±8.2)g/L比较,差异无显著性意义(t=2.019,P>0.05);局部并发症发生率仅5%,全身并发症发生率6%,胰腺手术率4%。结论静脉注射6%羟乙基淀粉130/0.4和呋噻米可改善急性胰腺炎的转归,血浆外渗是急性胰腺炎的中心事件和治疗重点。Objective To observe the effects of intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide on the outcome of acute pancreatitis patients. Methods 116 patients （54% of patients With a Ranson＇s score≥3 and 59% With a Balthazar CT≥D） admitted to our center were given intravenous infusions of hydroxyethylstarch （1000―2000 ml administered for an adult） soon after admission. At the same time,furosemide was administered as intravenous bolus,trying to maintain a fluid balance. The amount of hydroxyethylstarch administered was gradually reduced from the second day after admission. Results Blood volume was restored within 1～3 days after admission. Hematocrit after recovery 33.6±5.7 was significantly lower than that on admission 41.6±6.9（P 0.05）. Plasma albumin concentration after recovery （33.2±7.8） g/L was slightly lower than that on admission （36.3±8.2） g/L. Only 5% and 6% patients developed pancreatic and systemic complications respectively;In-hospital mortality rate was 3%. Conclusion Our study suggested that intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide might be beneficial for acute pancreatitis patients. Plasma extravasation is a central event of acute pancreatitis,and the reversal of hypovolemia is crucial for the success of treatment of acute pancreatitis.

关 键 词：急性胰腺炎 羟乙基淀粉 呋噻米 血浆外渗 

分 类 号：R576.05[医药卫生—消化系统]