重症急性胰腺炎患者早期液体复苏管理最佳证据的制定  

The formulation of the best evidence for early fluid resuscitation management of severe acute pancreatitis patients

作　　者：文秀 王倩[1] 刘明东[1] 田娟 李雪倩 曹燕平[1] Wen Xiu;Wang Qian;Liu Mingdong;Tian Juan;Li Xueqian;Cao Yanping(Department of Gastroenterology,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京鼓楼医院消化内科,南京210008

出　　处：《中华胰腺病杂志》2023年第4期265-271,共7页Chinese Journal of Pancreatology

基　　金：2010年国家临床重点专科建设项目([2011]872)。

摘　　要：目的制定SAP患者早期液体复苏管理的最佳证据。方法运用循证护理方法,针对SAP患者早期液体复苏管理的相关证据进行文献检索,依据"6S"证据金字塔顺序,检索中国知网(CNKI)、中国生物医学文献数据库(SinoMed)、万方数据库和UpToDate、NICE、RNAO指南网、国际胰腺病学、WHO协会网站、JBI、Cochrane、PubMed、EMBASE、CINAHL,检索时限为建库至2022年3月。运用JBI循证卫生保健中心的文献质量评价工具及证据预分级系统对纳入文献进行质量评价和证据等级判定,运用FAME结构对证据的可行性、适宜性、临床意义和有效性进行评价。结果最终纳入9篇文献,其中指南4篇,证据总结1篇,系统评价2篇,专家共识2篇。归纳出21条SAP患者早期液体复苏管理的证据,包含复苏时机、补液种类、补液总量及补液速度、动态监测、液体复苏目标5个方面。推荐SAP患者一经诊断应立即进行液体复苏,最迟72 h内进行液体复苏;优先推荐补充乳酸林格液,胶体液推荐补充人血白蛋白;补液的第1个24 h输注的液体总量占发病72 h补液总量的33.3%,对于早期休克或伴有脱水的患者,建议入院24 h内液体速度为5~10 ml·kg^(-1)·h^(-1),其中最初的30~45 min内可按20 ml/kg的液体量进行输注;建议每4~6 h评估早期液体复苏是否达标,复苏目标需满足以下指标中的2项以上,尿量0.5~1 ml·kg^(-1)·h^(-1)、平均动脉压65~85 mmHg、中心静脉压8~12 mmHg、心率<120次/min、中心静脉血氧饱和度≥70%、红细胞压积下降到30%~35%。结论通过循证护理方法制定了SAP患者早期液体复苏管理的最佳证据,有利于改善患者照护结局。Objective To establish the best evidence-based approach for early fluid resuscitation management in patients with severe acute pancreatitis(SAP).Methods A literature search was conducted utilizing evidence-based nursing methods to identify relevant evidence on the management of early fluid resuscitation in patients with SAP.The search followed the hierarchical order of the"6S"evidence pyramid,including databases such as China National Knowledge Infrastructure(CNKI),China Biomedical Literature Database(SinoMed),Wanfang Database,UpToDate,NICE,RNAO Guidelines Network,Pancreatology International,WHO Association Website,JBI,Cochrane,PubMed,EMBASE,and CINAHL.The search was limited to articles published from the establishment of each database to March 2022.The literature quality evaluation tools and an evidence pre-grading system from the JBI Evidence-Based Health Care Center were employed to assess the quality of the literature included in the study.Additionally,the FAME structure was utilized to evaluate the feasibility,appropriateness,clinical significance,and validity of the evidence.Results Nine articles were finally incorporated into the analysis,including four guidelines,one evidence summary,two systematic reviews,and two expert consensus articles.21 pieces of evidence pertaining to early fluid resuscitation management in patients with SAP was summarized,encompassing five key aspects:resuscitation timing,type of fluid infusion,total volume and speed of fluid infusion,dynamic monitoring,and fluid resuscitation goals.It was advisable for patients diagnosed with SAP to promptly receive fluid resuscitation,ideally within 72 hours of diagnosis.The initial choice for fluid resuscitation was lactated Ringer′s solution,with the addition of human albumin as a supplementary colloid solution.The quantity of fluid administered within the first 24 hours of rehydration should constitute approximately 33.3%of the total rehydration volume within the 72 hours time-frame.In the case of patients experiencing early shock or dehydr

关 键 词：重症急性胰腺炎 液体复苏 管理 证据总结 循证护理 

分 类 号：R576[医药卫生—消化系统]