羟乙基淀粉对重症急性胰腺炎合并腹腔高压患者早期腹腔压力及炎症因子的影响  

Effect of hydroxyethyl starch on early stage of abdominal pressure and inflammatory cytokines in severe acute pancreatitis patients with intra-abdominal hypertension

作　　者：孟凡水 阮长山 成忠了 杨冲[2] 何志强[3] 吴河水[3] 

机构地区：[1]通山县人民医院普外科,湖北省通山县437600 [2]华中科技大学同济医学院附属协和医院肿瘤中心、腹部肿瘤外科 [3]华中科技大学同济医学院附属协和医院肿瘤中心、胰腺外科

出　　处：《中华胰腺病杂志》2015年第1期1-5,共5页Chinese Journal of Pancreatology

摘　　要：目的探讨羟乙基淀粉治疗重症急性胰腺炎（SAP）合并腹腔高压（IAH）患者对早期腹腔压力（IAP）及炎症因子水平的影响。方法回顾性分析2007年11月至2013年10月武汉协和医院胰腺外科收治的55例SAP合并IAH患者的临床资料。患者入院后均采用非手术常规治疗。根据液体复苏方式的异同将患者分为研究组（24例）和对照组（31例）。研究组患者使用乳酸林格溶液联合6％羟乙基淀粉130／0．4氯化钠注射液行容量复苏；对照组患者仅使用乳酸林格溶液容量复苏。分析两组患者入院后1～8d的IAP、APACHEⅡ评分以及血清炎症因子水平的变化。结果两组患者的基本情况具有可比性。研究组入院后5～8d患者的IAP较对照组显著下降[（10．2±2．9）、（8．8±2．9）、（7．9±2．5）、（6．9±2．6）mmHg比（11．9±2．7）、（10．5±2．7）、（9．5±2．4）、（8．6±2．5）mmHg，1mmHg=0．133kPa]，差异有统计学意义（P值均〈0．05）；两组平均APACHE11评分无显著差异，但入院后5-8d相对基线的下降幅度研究组显著高于对照组，差异有统计学意义（P〈0．05）；入院后8d研究组患者血清IL-1、IL-8水平显著低于对照组[（15．1±13．7）μg／L比（23．6±13．5）μg／L，（11．2±12．8）μg／L比（23．8±27．9）μ/L]，差异有统计学意义（P值均〈0．05）；入院后4、8d研究组患者的TNF-α水平显著低于对照组[（31．9．4±12．1）μ/L比（43．4±22．4）μ/L，（24．2±12．8）μg／L比（35．1±15．3）μ/L]，差异有统计学意义（P值均〈0．05）。结论早期使用羟乙基淀粉130／0．4氯化钠注射液联合乳酸林格溶液进行液体复苏有助于改善SAP合并IAH患者的IAP及APACHEII评分，并下调IL-1、IL-8及TNF．仅水平。Objective To investigate the effect of hydroxyethyl starch （HES） 130/0.4 on intra- abdominal hypertension （IAH） and inflammatory cytokines in early stage of severe acute pancreatitis （SAP）. Methods Clinical data of 55 case of SAP with IAH from Nov 2007 to Oct 2013 in Pancreas Surgery Department of Wuhan Union Hospital were analyzed retrospectively. All patients received conventional treatment without operation. According to the method of fluid resuscitation, patients were divided into treatment group （n = 24） and control group （n = 31 ）. In treatment group, patients received ringer solution plus 6% HES 130/0.4 for fluid resuscitation, and patients in control group received only ringer solution for fluid resuscitation. The IAP level, APACHE Ⅱ score and serum inflammatory cytokine from day 1 to 8 were measured. Results The baseline data between the two groups were comparable. The IAP level was significantlylower in treatment group than that in control group from day 5 to day 8 [ （ 10.2 ± 2.9）, （ 8.8 ± 2.9）, （7.9 ±2.5）, （6.9±2.6）mmHgvs （11.9±2.7）, （10.5±.7）, （9.5±2.4）, （8.6±2.5）mmHg, 1 mmHg= 0. 133 kPa, respectively] , and the difference between the two groups was statistically significant （P 〈 0.05 ）. There was no significant difference in APACHE II score between the two groups, but the decline of APACHE Ⅱ score from baseline （ A APACHE 11 score） was more significant in treatment group （ P 〈 0.05 ）. The serum IL-1 and IL-8 level in treatment group at day 8 was lower than that in control group [ （ 15.1 ± 13.7） μg/L vs （ 23.6 ± 13.5 ） μg/L, （ 11.2 ± 12.8 ） μg/L vs （23.8 ± 27.9）μg/L, respectively ], and the difference between the two groups was statistically significant （ P 〈 0.05 ）. And the serum TNF-ct level in treatment group at day 4 and day 8 was lower than that in control group [ （ 31.9 ± 12.1 ） μg/L vs （ 43.4 ± 22.4 ） μg/L, （ 24.2 ± 12.8 ） μg/L vs （ 35.1±15.3 ） μg/L ] , and the d

关 键 词：胰腺炎 急性坏死性 腹腔 压力 羟乙基淀粉 炎症因子 

分 类 号：R657.51[医药卫生—外科学]