不同晶胶比液体早期复苏对重症急性胰腺炎患者预后的影响  

The impact of initial fluid resuscitation with different ratio of crystalloid-colloid on prognosis of patients with severe acute pancreatitis

作　　者：昌毓穗[1] 傅华群[2] 邹书兵[2] 喻本桐[1] 刘季春[1] 夏亮[1] 吕农华[1] 

机构地区：[1]南昌大学第一附属医院外科,江西330006 [2]南昌大学第二附属医院

出　　处：《中华危重病急救医学》2013年第1期48-51,共4页Chinese Critical Care Medicine

基　　金：江西省医药卫生科技计划支撑项目（20111018）

摘　　要：目的探讨不同晶胶比液体早期复苏对重症急性胰腺炎（SAP）患者预后的影响。方法回顾性分析本院2001年1月至2011年12月47例SAP患者的临床资料。以第一个24h液体晶胶比1．5和3为界，将患者分成低晶胶比组（晶胶比〈1．5，13例）、中晶胶比组（晶胶比1．5—3，15例）和高晶胶比组（晶胶比〉3，19例），观察入院后液体复苏成功患者的第一个24h机械通气率、氧合指数、腹腔内压（1AP）、第三间隙液体潴留量、液体复苏量参数及患者2周内存活率。结果①入院后第一个24h，高晶胶比组机械通气率显著高于中、低品胶比组（68．4％比20．0％、23．1％，均P〈0．05），氧合指数（mmHg，1mmHg=0．133kPa）明显低于中、低品胶比组（180．7±26.3比280．6±24．8、260.3±25．7，均P〈0．05），IAP（cmH2O，1cmH2O=0．098kPa）明显高于中、低晶胶比组（16．8±3．6比13．4±3．5、13．1±3.3，均P〈0．05），液体潴留量（ml）显著高于中、低晶胶比组（2834±631比1887±282、1865±300，均P〈0．05），而中晶胶比组与低晶胶比组比较差异均无统计学意义（均P〉0．05）。②入院后第一个24h，高晶胶比组输注晶体液量（ml）明显高于中、低晶胶比组（3611±798比2308±416、2124±477，均P〈0．05）；高、中晶胶比组胶体液量（ml）明显低于低晶胶比组（993±233、948±140比1506±332，均P〈0．05）：晶胶比值高晶胶比组（3．65±0．13）〉中晶胶比组（2．43±0．13）〉低晶胶比组（1．41±0．08，均P〈0．05）。复苏后72h，高晶胶比组总液体量（m1）明显高于中、低晶胶比组（11941±1161比9036±982、9400±1051，均P〈0．05）。③高晶胶比组2周内存活率（36．8％）显著低于中晶胶比组（86．7％，P〈0．05）和低品胶比组（61．5％，P〉0．05）。结论对SAP患者早期宜采用适当晶胶比的控制性液体复苏，可减轻体液潴留和提Objective To investigate the impact of fluid resuscitation with different ratio of crystalloid-colloid in early resuscitation stage on prognosis of patients with severe acute pancreatitis （SAP）. Methods A retrospective analysis was made by reviewing clinical data of 47 patients with SAP from January 2001 to December 2011. According to crystalloid-colloid ratio 1.5 or 3, which was the input volume of crystalloid fluid versus colloid fluid in the first 24 hours, patients were divided into low ratio group （crystalloid-colloid ratio〈1.5, n =13）, middle ratio group （crystalloid-colloid ratio 1.5-3, n = 15 ） and high ratio group （crystalloid-colloid ratio 〉3, n = 19）. Among the patients who had been successfully resuscitated, rate of mechanical ventilation, the oxygenation index, intra-abdominal pressure （IAP）, and the amount of fluid retention in the third space within the first 24 hours, as well as the parameters of fluid resuscitation and the survival rate within 2 weeks were collected and analyzed. Results .①In the first 24 hours, the rate of mechanical ventilation in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group （68.4% vs. 20.0%, 23.1%, both P〈0.05）; the oxygenation index （mm Hg, 1 mm Hg= 0.133 kPa） was significantly lower than that in the middle ratio group and in the low ratio group （180.7 226.3 vs. 280.6 2 24.8, 260.3 ± 25.7, both P〈0.05）; the IAP （cm H2O, 1 cm H2O =0.098 kPa） was significantly higher than that in the middle ratio group and the low ratio group （ 16.8 ± 3.6 vs. 13.4 ± 3.5, 13.1 ± 3.3, both P〈0.05） ; the amount of fluid retention （ml） in the third space was significant higher than that in the middle ratio group and the low ratio group （2834 2 631 vs. 1887 2 282, 1865 ± 300, both P〈0.05）. There was no significant difference in above indexes between middle ratio group and low ratio group （all P〉0.05）. ② In the first 24 hours, the volume of crystaUoid （ml） in hig

关 键 词：胰腺炎 急性 重症 液体复苏 晶胶比 存活率 

分 类 号：R576[医药卫生—消化系统]