不同晶胶比液体复苏对重症急性胰腺炎患者血管外肺水指数的影响  

The effects of fluid resuscitation with different crystalloid-colloid ratio on extravascular lung water index in severe acute pancreatitis

作　　者：冯永文[1] 吴明[1] 曾晶晶[1] 李颖[1] 李明利[1] 崔曼丽[1] 

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)重症医学科,广东518035

出　　处：《中国危重病急救医学》2011年第8期458-461,共4页Chinese Critical Care Medicine

基　　金：广东省深圳市科技计划项目（200902039）

摘　　要：目的探讨不同晶胶比液体复苏对重症急性胰腺炎（SAP）患者血管外肺水（EVLW）的影响。方法回顾性分析本院2009年1月至2010年12月重症医学科24例SAP患者的临床资料。所有患者的胸内血容量指数（ITBVI）均〈750ml／m^2，以ITBVI850～1000ml／m^2作为复苏终点。以晶胶比3：1为界，将患者分成低晶胶比组（13例）和高晶胶比组（11例），观察液体复苏前及复苏后即刻（0）、24、48、72h患者血流动力学、血管外肺水指数（EVLWI）、氧合指数（PaO2／FiO2）、膀胱内压（ICP）、B型钠尿肽（BNP）的变化；采用脉搏指示连续心排血量（PiCCO）热稀释法测定EVLWI，用放射免疫法测定BNP。结果①早期采用不同晶胶比液体复苏均可改善SAP患者血流动力学指标。②复苏后72h高晶胶比组总液体量[（16438±1758）ml]、晶体液量[（13459±425）ml]及晶／胶比值（4．50±0．23）均明显高于低晶胶比组[分别为（13895±1783）ml、（6945±454）ml、2．32±0．18，P〈0．05或P〈0．01]。③与低晶胶比组比较，高晶胶比组复苏后48h和72hPaO2／FiO2（mmHg，1mmHg=0．133kPa）明显下降（48h：186．51±42．26比268．35±34．18，72h：172．85±21．50比263．95±24．20），EVLWI、ICP及BNP均明显升高[EVLWI（ml／kg）48h：14．52±1．08比10．40±1．16，72h：14．92±0．86比10．52±1．02；ICP（cmH2O，1cmH2O=0．098kPa）48h：16．23±1．32比13．05±1．70，72h：17．39±1．56比13．42±1．65；BNP（ng／L）48h：424．29±74．25比225．32±53．58，72h：620．49±79．53比288．28±68．78，P〈0．05或P〈0．013。④Pearson相关分析显示：EVLwI与PaO2／FiO2呈显著负相关（r=-0．71，P〈0．01），与ICP、BNP呈显著正相关（r1=0．63，r2=0．56，均P〈0．01）。结论对SAP患者早期应监测EVLWI、ICP及BNP以指导液体复苏，且宜采用提高胶体比例的限制性液体复苏策略。Objective To investigate the effects of fluid resuscitation with different crystalloid-eolloid ratio on extravascular lung water （EVLW） in patients with severe acute pancreatitis （SAP）. Methods Clinical data of 24 SAP patients,who had undergone intrathoraeic blood volume index （ITBVI 〈750 ml/m^2）, were analyzed retrospectively, in Department of Critical Care Medicine in the First Affiliated Hospital of Shenzhen University, during January of 2009 to December of 2010. ITBVI 850 1 000 ml/m^2 was confirmed the end criterion of the end point of resuscitation. Low crystalloid-eolloid ratio group （n= 13） and high crystalloid-colloid ratio group （n= 11） were divided according to crystalloid-eolloid ratio （3 ： 1） as the borderline. Hemodynamic parameters, extravascular lung water index （EVLWI）, oxygenation index （PaO2/FiO2）, bladder pressure （ICP） and B-type natriuretic peptide （BNP） were observed at the time point of before fluid resuscitation, and 0, 24 ,48, 72 hours after resuscitation, EVLWI was measured with thermal dilution pulse index continuous cardiac output （PiCCO）, and BNP with radioimmunoassay. Results ①Hemodynamic parameters can be improved at early fluid resuscitation stage in both groups. ② The total amount of fluid [（16 438±1 758） ml], amount of crystalloid fluid [（13 459±425） ml] and crystalloid-colloid ratio （4.50±0.23） of the high crystalloid-colloid ratio group was significantly higher than that of the low crystalloid-colloid ratio group [（13 895±1 783） ml, （6 945 ±454） ml, 2.32±0.18, respectively, P〈0.05 or P〈0.01] at the time point of 72 hours after resuscitation. ③ Compared with low crystalloid-colloid ratio group, PaO2/FiO2 （mm Hg, 1 mm Hg= 0. 133 kPa） in high erystalloid-colloid ratio group was lowered significantly at 48 hours and 72 hours after resuscitation （48 hours： 186.51 ± 42.26 vs. 268.35 ± 34.18, 72 hours： 172.85 ±21.50 vs. 263.95 ± 24. 20）; but EVLWI, ICP and BNP were increased significant

关 键 词：胰腺炎 急性 重症 液体复苏 晶胶比 血管外肺水指数 膀胱内压 B型钠尿肽 

分 类 号：R576[医药卫生—消化系统]