中心静脉导管引流重症急性胰腺炎腹腔积液的临床研究  

Clinical study of the central venous catheter specialized for continuous drainage of exudates from severe acute pancreatitis （SAP） in patients with seroperitoneum

作　　者：李俊英[1] 董芸[1] 章晓红[1] 陈友岱[1] 郑君[1] 苏明华[1] 

机构地区：[1]四川省人民医院急救中心,成都610072

出　　处：《中华急诊医学杂志》2013年第10期1096-1099,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨中心静脉置管持续腹腔引流在重症急性胰腺炎（SAP）的临床应用。方法将62例重症急性胰腺炎且有腹腔积液的患者，采用随机（随机数字法）分为中心静脉置管腹腔引流组（观察组，31例）和常规治疗组（对照组，31例）。两组均给予相同内科治疗，观察组给予中心静脉导管腹腔置管持续引流。检测两组患者引流前及引流后第12h、24h、48h、72h腹腔压力（IAP），乳酸（LAC），降钙素原（PCT），并观察患者腹痛、腹胀及肠道功能恢复时间及多器官功能不全（MODS）发生率。结果对照组患者均一次穿刺引流成功，观察组腹腔压力、乳酸、降钙素原较对照组均不同程度降低；腹痛、腹胀症状缓解，肠道功能恢复时间缩短；MODS发生率明显低于对照组。结论中心静脉腹腔置管持续引流治疗重症急性胰腺炎，是一种安全有效的引流方式．值得临床广泛应用。Objective To investigate the application of the central venous catheter （CVC） specialized for drainage intervention in severe acute pancreatitis （SAP） patients. Methods Sixty-two severe acute pancreatitis patients with seroperitoneum were randomly （random number） assigned into two groups ： the drainage group （ n = 31 ） and the control group （ n = 31 ）. All patients were treated with conventional internal medicine therapy. Patients of drainage group were treated with continuous peritoneal drainage by using the central venous catheter. The intra-abdominal pressure （IAP）, lactic acid （LAC）, and procalcitonin （PCT） were detected before and 12 h, 24 h, 48 h, 72 h, 5 days after intraperitoneal drainage. The symptoms of abdomen pain, abdomen distention, resume of bowel movement and the rate of MODS were observed. Results All patients with drainage got catheter successfully inserted. Compared with the control group, the lAP, LAC and PCT decreased significantly in the patients of drainage group. And the duration of abdomen pain, abdomen distention and resume of bowel movement function in the drainage group were shorter and the rate of MODS was lower. Conclusions Application of CVC specialized for intraperitoneal drainage is a safe and effective method for the treatment of pancreatitis with seroperitoneum. It is worthwhile to be widely used in clinic.

关 键 词：中心静脉导管 重症急性胰腺炎 腹腔积液 引流 腹内压 乳酸 降钙素原 多器官功能不全 

分 类 号：R576[医药卫生—消化系统]