早期积极液体复苏对初始评估未达到重型标准的急性胰腺炎患者的影响研究  

Impact of Early Active Fluid Resuscitation on Patients Initially Assessed as Non-severe Acute Pancreatitis

作　　者：刘俊 武鹏宇 刘莉[2] 孙晓滨[2] LIU Jun;WU Pengyu;LIU Li;SUN Xiaobin(Southwest Medical University,Luzhou 646000,China;Department of Gastroenterology,the Third People's Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]西南医科大学,四川省泸州市646000 [2]四川省成都市第三人民医院消化科,610031

出　　处：《中国全科医学》2021年第27期3457-3463,共7页Chinese General Practice

摘　　要：背景液体复苏是急性胰腺炎(AP)早期治疗的关键环节,但目前关于初始评估未达到重型标准的AP患者的液体复苏方案研究较少,而早期积极液体复苏对非重型AP向重型AP转化及预后的影响尚无定论。目的探讨早期积极液体复苏对初始评估未达到重型标准的AP患者的影响。方法选取成都市第三人民医院消化科2018-01-01至2018-12-31收治的初始评估未达到重型标准的AP患者219例,根据入院后24 h液体复苏总量分为对照组118例(液体复苏总量<3200 ml)和观察组101例(液体复苏总量≥3200 ml)。在常规治疗基础上,对照组患者采用常规液体复苏,观察组患者采用积极液体复苏。比较两组患者入院后24、48、72 h液体复苏总量,临床转归,治疗后3、7 d液体复苏达标率及转为重型AP者所占比例,并进行亚组分析。结果观察组患者入院后24 h液体复苏总量大于对照组,禁食水时间长于对照组,治疗后3、7 d液体复苏达标率高于对照组,全身炎症反应综合征(SIRS)发生率及治疗后3、7 d转为重型AP者所占比例低于对照组(P<0.05)。亚组分析结果显示:采用积极液体复苏方案治疗的轻型AP患者禁食水时间长于采用常规液体复苏方案治疗者,SIRS发生率高于采用常规液体复苏方案治疗者(P<0.05);采用常规液体复苏方案治疗的中度重型AP患者禁食水时间、住院时间长于轻型AP患者,行机械通气者所占比例、行有创/介入治疗者所占比例、转重症监护室(ICU)者所占比例及治疗后3、7 d转为重型AP者所占比例高于轻型AP患者(P<0.05);采用积极液体复苏方案治疗的中度重型AP患者禁食水时间长于轻型AP患者,治疗后7 d转为重型AP者所占比例高于轻型AP患者(P<0.05)。结论早期积极液体复苏(入院后24 h液体复苏总量大于入院后48 h液体复苏总量的1/2或≥3200 ml)有利于改善初始评估未达到重型标准的AP患者临床转归,提高液体复苏达标率,�Background Fluid resuscitation is considered as the key of early treatment of acute pancreatitis(AP),but there are few reports about the fluid resuscitation scheme in patients initially assessed as non-severe AP,moreover,the impact of early active fluid resuscitation on the progression of non-severe AP to severe AP and prognosis is inconclusive.Objective To investigate the impact of early active fluid resuscitation on patients initially assessed as non-severe AP.Methods From 1 January to 31 December,2018,219 patients initially assessed as non-severe AP were selected from Department of Gastroenterology,the Third People's Hospital of Chengdu and divided into control group(n=118,using conventional treatment plus regular fluid resuscitation with fluid volume<3200 ml administered within 24 hours of admission)and observation group(n=101,using conventional treatment plus active fluid resuscitation with fluid volume≥3200 ml administered within 24 hours of admission).Total volume of fluid resuscitation at 24,48 and 72 hours after admission,clinical outcome,rate of reaching the improved criteria by fluid resuscitation as well as rate of progression to severe AP 3 and 7 days after treatment were compared between the two groups,and subgroup analysis was conducted.Results Compared to control group,observation group had larger total volume of fluid resuscitation administered within 24 hours of admission,longer fasting time for solids and liquids,higher rate of reaching the improved criteria by fluid resuscitation and lower rate of progression to severe AP 3 and 7 days after treatment,as well as lower incidence of systemic inflammatory response syndrome(SIRS)(P<0.05).Subgroup analysis indicated that,compared to the controls,mild patients in observation group had longer fasting time for solids and liquids,and higher incidence of SIRS(P<0.05).In control group,longer fasting time for solids and liquids as well as hospital stays,higher rates of undergoing mechanical ventilation and invasive/interventional treatment,transferring t

关 键 词：胰腺炎 复苏 补液疗法 液体复苏 临床转归 预后 

分 类 号：R576[医药卫生—消化系统]