苯磺顺阿曲库铵辅助治疗重症急性胰腺炎合并腹内高压的回顾性分析  

A retrospective study of cisatracurium besilate-assisted treatment of severe acute pancreatitis complicated with intraabdominal hypertension

作　　者：李娜[1] 张艳芳[1] 刘沙沙[1] 谢子雷 穆蕊 张圆[1] 余剑波[1] Li Na;Zhang Yanfang;Liu Shasha;Xie Zilei;Mu Rui;Zhang Yuan;Yu Jianbo(Tianjin Medical University Nankai Hospital Department of Anesthesiology and Critical Care Medicine,Tianjin Nankai Hospital,Tianjin 300100,China)

机构地区：[1]天津医科大学南开临床学院,天津市南开医院麻醉科和重症医学科,天津300100

出　　处：《中华麻醉学杂志》2022年第5期591-594,共4页Chinese Journal of Anesthesiology

摘　　要：回顾性收集2018年1月1日至2021年10月1日本院重症医学科收治的重症急性胰腺炎合并腹内高压或腹腔间隔室综合征患者的临床资料,根据是否使用苯磺顺阿曲库铵将患者分为常规治疗联合静脉泵注苯磺顺阿曲库铵组(肌松组)和常规治疗组,采用治疗倾向性评分预测模型进行配对筛选,每组31例。常规治疗组采取常规治疗,包括胃肠减压、解痉镇痛、补液、抑酸、抑酶、营养支持、机械通气、灌肠等;肌松组在常规治疗的基础上静脉泵注苯磺顺阿曲库铵,首剂量为0.15 mg/kg进行辅助气管内插管,随后以1~3μg·kg^(-1)·min^(-1)静脉泵注,根据患者的基础生命体征及临床效果对剂量进行调整。主要结局指标为生存率。次要结局指标为治疗前及治疗第7、14、20天腹内压、氧合指数、排便次数、排便量和排尿量,以及治疗期间肠鸣音恢复时间、机械通气时间、ICU治疗时间和总住院费用。与常规治疗组比较,肌松组生存率升高,治疗第7、14、20天时腹内压降低,氧合指数升高,治疗第7、14天时排便次数和排便量增多,治疗前和治疗第7天尿量增多,肠鸣音恢复时间缩短(P<0.05),治疗第14、20天尿量、机械通气时间、ICU治疗时间和总住院费用比较差异无统计学意义(P>0.05)。综上所述,苯磺顺阿曲库铵辅助治疗重症急性胰腺炎合并腹内高压患者,可改善氧合状况,促进肠道功能恢复,提高生存率。The clinical data of patients with severe acute pancreatitis complicated with intraabdominal hypertension or abdominal compartment syndrome admitted to our Department of Critical Care Medicine from January 1,2018 to October 1,2021 were collected and analyzed.Patients were divided into a conventional treatment group and conventional treatment plus IV infusion of cisatracurium besilate group(muscle relaxation group).A prediction model of treatment propensity score was developed for paired screening,with 31 cases in each group.The conventional treatment group adopted conventional basic treatment methods such as gastrointestinal decompression,spasmolysis and analgesia,fluid therapy,inhibition of gastric acid,suppression of parenzyme,nutritional support,mechanical ventilation,and enemata.In muscle relaxation group,cisatracurium besilate was intravenously infused on the basis of routine treatment with the initial dose of 0.15 mg/kg given to facilitate endotracheal intubation,followed by continuous intravenous infusion at 1-3μg·kg^(-1)·min^(-1),and the dose was adjusted according to the patient′s basic vital signs and clinical effects.The primary outcome was survival rate.Secondary outcome measures were changes in intraabdominal pressure,oxygenation index,the number of defecation,volume of defecation,and urination volume before treatment and on 7,14 and 20 days of treatment.and the recovery time of bowel sounds,length of mechanical ventilation,time of intensive care unit treatment,and total hospitalization costs.Compared with conventional treatment group,the survival rate was significantly increased,the intraabdominal pressure was decreased on 7,14 and 20 days of therapy,the oxygenation index was increased,the number of defecation and volume of defecation were increased on 7 and 14 days of therapy,urinary volume was increased before treatment and on day 7 of therapy,the recovery time of intestinal sound was significantly shortened(P<0.05),and no significant change was found in urinary volume on days 14 and 20 of th

关 键 词：阿曲库铵 胰腺炎 腹内高压 

分 类 号：R576[医药卫生—消化系统]