早期目标导向液体复苏对重症急性胰腺炎疗效分析  

Effect of early goal-directed fluid resuscitation on severe acute pancreatitis

作　　者：王长亮 王春丹[2] 苏伟 WANG Changliang;WANG Chundan;SU Wei(Department of Intensive Care Unit,Sir Run Run Shaw Hospital Affiliated to Zhejiang University,Hangzhou 310000,China;Department of Pathology,the First Affiliated Hospital of Zhejiang Chinese Medicine University,Hangzhou 310000,China)

机构地区：[1]浙江大学附属邵逸夫医院重症医学科,浙江杭州310000 [2]浙江中医药大学附属第一医院病理科,浙江杭州310000

出　　处：《中国现代医生》2018年第32期88-91,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2018RC050)

摘　　要：目的评价早期目标导向液体复苏治疗对重症胰腺炎患者预后的影响。方法将2016年10月～2018年2月我院重症监护病房(ICU)收治的重症急性胰腺炎患者72例随机分为两组:实验组采用早期目标导向液体复苏治疗,对照组采用重症急性胰腺炎常规液体治疗72 h,比较两组患者生命体征、血流动力学参数和实验室检查等。结果实验组和对照组患者72 h复苏液体总量分别为(14500±930)mL、(12400±825)mL,两组比较差异有统计学意义(P<0.01);治疗后实验组腹内压与对照组比较,差异无统计学意义(P>0.05);实验组的APACHEⅡ评分低于对照组(P<0.05);实验组血乳酸、白介素6(IL-6)、C-反应蛋白均低于对照组(P<0.05);实验组患者ICU住院日、需要手术减压率均低于对照组(P<0.05)。但两组患者ICU病死率、28 d生存率无明显差异。结论对重症急性胰腺炎患者进行早期目标导向液体复苏治疗能达到较好的液体复苏效果,改善患者的循环状态、减轻炎症反应,降低腹腔内高压发生率。Objective To evaluate the effect of early goal-directed fluid resuscitation on the prognosis of patients with severe pancreatitis.Methods72patients with severe acute pancreatitis who were admitted in our intensive care unit(ICU)from October2016to February2018were randomly divided into two groups.The experimental group was treated with early goal-directed liquid resuscitation,and the control group was treated with severe acute pancreatitis conventional liquid for72hours.The vital signs,hemodynamic parameters and laboratory examinations were compared between the two groups.Results The total amount of resuscitation fluid in the experimental group and the control group was(14500±930)mL and(12400±825)mL,respectively.There was a significant difference between the two groups(P<0.01).There was no significant difference in intra-abdominal pressure between the experimental group and the control group after treatment(P>0.05).The APACHEII score was lower in the experimental group than that in the control group(P<0.05).The blood lactate,interleukin-6(IL-6)and C-reactive protein in the experimental group were lower than those in the control group(P<0.05).The ICU stay and the need for surgical decompression rate were lower in the experimental group than that in the control group(P<0.05).However,there was no significant difference in ICU mortality rate and28-day survival rate between the two groups.Conclusion Early goal-directed fluid resuscitation in patients with severe acute pancreatitis patients can achieve better fluid resuscitation,improve the patient's circulation status,reduce inflammation,and reduce the incidence of intra-abdominal hypertension.

关 键 词：目标导向 液体复苏 重症胰腺炎 预后 

分 类 号：R657.51[医药卫生—外科学]