大容量与限制性液体复苏对重症急性胰腺炎患者血流动力学及预后的影响比较  

Effects of large-volume versus restrictive-volume fluid resuscitation on hemodynamics and prognosis in patients with severe acute pancreatitis

作　　者：陈良[1] 蔡兆辉[1] 李海山[1] Chen Liang;Cai Zhaohui;Li Haishan(Department of Emergency,The Second People's Hospital of Hefei,Hefei 230011,Anhui Province,China)

机构地区：[1]合肥市第二人民医院急诊科,合肥230011

出　　处：《中国基层医药》2022年第5期655-659,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较大容量与限制性液体复苏对重症急性胰腺炎(SAP)患者血流动力学及预后的影响。方法选取合肥市第二人民医院2018年3月至2020年12月收治的SAP患者102例为研究对象,采用随机数字表法分为对照组、研究组,每组51例。对照组采取大容量液体复苏,研究组采取限制性液体复苏。比较两组复苏前后血流动力学指标、腹内压、肺功能。患者入院后随访28 d并记录其预后情况。结果研究组复苏12 h、复苏24 h的胸腔内血容量指数(ITBVI)、全心舒张末期容积指数(GEDVI)、心脏指数(HI)、中心静脉压(CVP)均高于对照组(均P<0.05);研究组复苏6 h的HI、CVP分别为(4.87±0.48)、(11.04±2.08),均高于对照组的(4.53±0.57)、(9.48±1.67)(t=3.25、4.17,均P<0.05)。复苏前,两组腹内压差异无统计学意义(P>0.05);复苏后,两组腹内压均低于复苏前(均P<0.05),研究组腹内压[(12.78±2.35)cmH_(2)O]低于对照组[(15.01±2.42)cmH_(2)O](t=4.72,P<0.05)。复苏前,两组血氧分压(PaO_(2))、氧合指数(OI)差异均无统计学意义(均P>0.05);复苏后,两组PaO_(2)、OI均高于复苏前(均P<0.05),研究组PaO_(2)、OI均高于对照组(t=3.02、5.55,均P<0.05)。研究组腹腔间隔室综合征发生率、有创机械通气率分别为27.45%(14/51)、35.29%(18/51),均低于对照组的47.06%(24/51)、56.86%(29/51)(χ^(2)=4.19、4.77,均P<0.05)。两组多脏器功能障碍综合征发生率、急性肾损伤发生率、腹腔穿刺引流率、病死率差异均无统计学意义(均P>0.05)。结论与大容量液体复苏相比,限制性液体复苏更能改善SAP患者血流动力学指标及肺功能,明显降低患者腹内压,改善患者预后。Objective To explore the effect of large-volume versus restrictive fluid resuscitation on hemodynamics and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 102 patients with severe acute pancreatitis who received treatment in The Second People's Hospital of Hefei,China between March 2018 and December 2020 were included in this study.They were randomly assigned to undergo large-volume fluid resuscitation(control group,n=51)or restrictive-volume fluid resuscitation(study group,n=51).Hemodynamic indexes,intra-abdominal pressure and pulmonary function were compared between the two groups before and after resuscitation.All patients were followed up for 28 days after admission and their prognosis was recorded.Results At 12 and 24 hours of resuscitation,intrathoracic blood volume index,global end-diastolic volume index,cardiac index,and central venous pressure in the study group were significantly higher than those in the control group(all P<0.05).At 6 hours of resuscitation,cardiac index and central venous pressure in the study group were(4.87±0.48)and(11.04±2.08),respectively,which were significantly higher than those in the control group[(4.53±0.57),(9.48±1.67),t=3.25,4.17,both P<0.05)].Before resuscitation,there was no significant difference in intra-abdominal pressure between the two groups(P>0.05).After resuscitation,intra-abdominal pressure in each group was significantly lower compared with that before resuscitation(both P<0.05).After resuscitation,intra-abdominal pressure in the study group was significantly lower than that in the control group[(12.78±2.35)cmH_(2)O vs.(15.01±2.42)]cmH_(2)O,t=4.72,P<0.05).Before resuscitation,there were no significant differences in PaO_(2) and oxygenation index between two groups(both P<0.05).After resuscitation,PaO_(2) and oxygenation index in each group were significantly higher compared with those before resuscitation(both P<0.05).After resuscitation,PaO_(2) and oxygenation index in the study group were significantly higher than those in the

关 键 词：胰腺炎 急性坏死性 复苏术 离子液体 血流动力学 预后 胸腔内血容量指数 全心舒张末期容积指数 心脏指数 中心静脉压 腹腔间室综合征 

分 类 号：R576[医药卫生—消化系统]