重症急性胰腺炎早期目标治疗研究  

Early goal-directed therapy in severe acute pancreatitis

作　　者：朱研[1] 陈宏[1] 杨磊[1] 刘大川[1] 杨鹏[1] 贾建国[1] 孙家邦[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京100053

出　　处：《中华肝胆外科杂志》2011年第6期459-461,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究两种不同液体复苏目标在重症急性胰腺炎治疗中的差别。方法选取2000年1月至2010年1月间80例重症急性胰腺炎患者，按时间顺序分为2组。A组治疗目标为24h内：①血压控制在90／60mmHg（1mmHg=0．133kPa）以上；②中心静脉压控制在8-12mmHg；③尿量控制在0．5ml·kg^-1·h^-1以上。B组治疗目标按照2004年SSC早期目标治疗标准执行，6h内：①平均动脉压大于65mmHg；②中心静脉压8～12mmHg；③尿量大于0．5ml·kg^-1·h“以上；④中心静脉血氧饱和度大于70％。观察患者液体治疗3d后的Marshall评分、APACHEⅡ评分及患者胰周感染率和病死率。结果治疗3d后，Marshall评分A组为6．82±4．69，B组为4．48±3．78，两者之间差异有统计学意义（P-0．02）；APACHEⅡ评分A组为11．35±5．96，B组为8．22±4．53，两者之间差异有统计学意义（P=0．01）。A组胰周感染率和病死率分别为44％和24％，B组胰周感染率和病死率分别为37％和17％，两者之间差异无统计学意义（P值分别为0．65和0．57）。结论按照SSC指南早期目标治疗标准对重症胰腺炎患者行液体复苏可以改善治疗3d患者脏器功能，但不能显著改善患者的胰周感染率和病死率。Objective To study the difference in outcomes between two treatment regimens of goal-directed fluid therapy in patients with severe acute pancreatitis. Methods From January 2000 to January 2010, 80 patients with severe acute pancreatitis were assigned into 2 groups. In group A, patients received fluid therapy aiming at the following goals in 24 hours： （1） Blood pressure 〉90/60 mm Hg; （2） CVP between 8-12 mm Hg; （3） Urine output 〉0.5 ml · kg-1 · h^-1. In group B, patients received fluid therapy aiming at the following goals in 6 hours （according to SSC guideline, 2004） ： （1） mean arterial blood pressure 〉65 mm Hg; （2） CVP between 8-12 mm Hg; （3） Urine output〉0.5 ml · kg-1 · h 1 ; （4） central venous oxygen saturation〉70 %. After therapy for 3 days we measured the Marshall score, APACHE Ⅱ score,and the peri-pancreatic infection and mortality rates. Results The Marshall score was 6.82±4.69 and 4.48±3.78 in group A and B, respectively （P=0.02）. The APACHE Ⅱ score was 11.35±5.96 and 8.22±4.53 in group A and B, respectively （P=0.01）. The peri-pancreatic infection rate was 44%and 37% in group A and B, respectively, and there was no significant difference between the 2 groups （P=0.65）. The mortality rate was 24% and 17% in group A and B. There was no significant difference between the 2 groups （P=0.57）. Conclusion Goal-directed fluid therapy in patients with severe acute pancreatitis according to the SSC guideline improved organ function but it did not reduce peri-pancreatic infection and mortality rates.

关 键 词：重症急性胰腺炎 液体复苏 早期目标治疗 Marshall评分 APACHE Ⅱ 

分 类 号：R576[医药卫生—消化系统]