早期腹腔置管引流治疗重症急性胰腺炎  

Early drainage of ascites for the treatment of severe acute pancreatitis

作　　者：邢金燕[1] 燕晓雯[1] 孙运波[1] 董泽华[1] 苏媛[1] 

机构地区：[1]青岛大学医学院附属医院重症医学科,山东省青岛266003

出　　处：《中华急诊医学杂志》2010年第4期405-408,共4页Chinese Journal of Emergency Medicine

摘　　要：目的采用前瞻性随机对照临床研究，观察早期腹腔内留置导管引流对急性重症胰腺炎患者的治疗效果。方法2007年1月至2009年1月综合ICU收治患者，符合SAP临床诊断标准，年龄≥18岁。排除24h内死亡，Marshall评分≥20分，有明确腹腔感染，既往腹腔手术者。所有入选者均不参加其他可能影响胰腺炎病情的治疗研究，收集重症急性胰腺炎患者30例。按随机数字表随机分为A、B两组，入院时即经尿道膀胱插入Forley尿管，测定膀胱内压／腹内压，留置胃管，接胃肠减压，计量；呼吸衰竭者应用机械通气，记录呼吸机应用时间。A组为常规治疗组，16例，采用常规治疗；B组为引流组，14例，在常规治疗的基础上早期腹腔置管引流，计量。记录两组患者第0，3，7，10天腹内压、腹腔引流量、肠呜音、胃肠减压量，相应时间点采血测定患者血浆前白蛋白（PA）、C反应蛋白（CPR）水平，评定急性生理及慢性健康状况评分（APACHEⅡ评分）和器官衰竭评分（Marshall评分）。组间及组内数据进行方差分析，组间数据采用t检验，以P〈0．05为差异具有统计学意义。结果入选时两组患者各指标差异无统计学意义，第3天起APACHEⅡ评分[（25．36±12．58）vs．（16．81±13．19），P〈0．05]、Marshall评分[（11．47±4．02）vs．（6．09±3．71），P〈0．05]、腹内压[（22．5±5．1）VS．（12．7±6．3），P〈0．05]、CRP[（304．16±86．51）vs．（198．65±94．37），P〈0．05]、胃肠减压量[（1033±451）vs（654±290），P〈0．05]均显著降低，引流组的呼吸机应用时间低于常规治疗组[（7．13±2．22）dvs．（4．07±1．78）d）]，28d生存率提高（92．86％vs．81．25％）。结论胰腺炎相关性腹水在SAP病情进展过程中起重要作用，早期腹腔内置管引流可明显改善患者病情，减轻炎性反应，有利于肠功能和呼吸功能的Objective To investigate the clinical effects of early drainage of ascites for the treatment of severe acute pancreatitis （SAP）. Method A total of 30 patients with ASP were enrolled depending on the criteria of ASP with age over 18 years admitted to ICU from Jan 2007 to Jan 2009. Patients, who died within 24 hours after admission, and had Marshall Score over 20, definite infection in abdonrinal cavity and previous laparotomy, were excluded. Intravesical pressure/intra-abdominal pressure was measured in all patients with a Fodey＇ s catheter inserted through urethra into bladder. All patients were randomized to have either routine treatment alone （group A, n = 16） or routine treatment with early drainage of ascites （group B, n = 14）. The scores of APACHE Ⅱ and Marshall of all patients were recorded at admission and on the 3 rd, 7 th and lOth days. Concurrently, the measurements of the intra-abdominal pressure （IAP）, the amount of ascites drained from abdominal cavity, the bowel sound, the volume of gastrointestinal decompression, and the days of mechanical ventilation employed were documented, and the levels of plasma pre-albumin （PA） and C-reactive protein （CRP） were measured as well. The analyses of variance and t -test were used for the comparison of inter-and between groups. P 〈 0.05 was considered statistical significance. Results There was no statistical difference in all measurements between two groups at admission. From the 3rd day on, there were significant distinctions between two groups in the score of APACHE Ⅱ [（16.81 ± 13.19） vs. （25.36± 12.58, P 〈0.05], the score of Marshall [（6.09±3.71） vs. （11.47±4.02）, P 〈0.05], the IAP [（12.7±6.3） vs. （22.5±5.1）, P 〈0.05], the levelofCRP [（198.65± 94.37） vs. （304.16 ±86.51）, P 〈 0.05], and the volume of gastrointestinal decompression [ （654 ± 290） mL vs. （1033 ± 451 ） mL, P 〈 0.05 ]. The time of mechanical ventilation employed in group B was obviously shorter than that in gro

关 键 词：重症急性胰腺炎 胰腺炎相关性腹水 腹腔引流 前白蛋白 C反应蛋白 急性生理及慢 性健康状况评分 器官衰竭评分 腹内压 

分 类 号：R576[医药卫生—消化系统]