早期液体管理对急性胰腺炎患者C反应蛋白及严重程度进展的影响  

The impact of early fluid management on C-reactive protein levels and the severity and progression in the patients with acute pancreatitis

作　　者：赵振 颜律诚 王国兴[1] Zhao Zhen;Yan Luvcheng;Wang Guoxing(Emergency Department,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《中国急救医学》2024年第10期878-883,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探究早期液体管理对急性胰腺炎(acute pancreatitis,AP)患者C-反应蛋白(C-reactive protein,CRP)及严重程度进展的影响。方法回顾性收集2016年1月至2022年10月首都医科大学附属北京友谊医院急诊科收治的214例AP患者,记录患者一般资料、CRP、入院0~24 h及24~48 h的补液速度等。计算补液速度的平均值,小于平均补液速度患者为低补液速度组,大于平均补液速度患者为高补液速度组。以平均住院时间、1周后AP是否进展、新发心功能不全、新发肾功能不全、住院生存率为结局指标,分析早期(0~24 h及24~48 h)不同补液速度对AP患者CRP及严重程度进展的影响。结果AP患者补液速度均数为29.6 mL/(kg·24 h),入院0~24 h及24~48 h低补液速度组[<29.6 mL/(kg·24 h)]的女性比例均明显高于男性(P<0.05);入院0~24 h低补液速度组第3、5、7天CRP水平均高于高补液速度组(Z=-2.659、-2.541、-2.191,P均<0.05);入院24~48 h低补液速度组第1、3、5天CRP水平均高于高补液速度组(Z=-2.121、-2.288、-2.208,P均<0.05)。入院0~24 h高、低补液速度组平均住院时间分别为(8.60±4.17)d及(9.01±4.21)d,两组比较差异无统计学意义。入院1周后再次评估AP的危重程度,15例出现轻症向重症进展,其中0~24 h低补液速度组9例,高补液速度组6例,低补液速度组1周后向重症进展的相对危险系数1.081(0.406~2.874)。8例存在新发心功能不全,其中低补液速度组3例,高补液速度组5例,高补液速度组发生新发心功能不全相对危险系数1.022(0.969~1.078)。10例存在新发肾功能不全,其中低补液速度组4例,高补液速度组6例,低补液速度组发生新发肾功能不全相对危险系数1.023(0.963~1.086)。结论AP早期液体管理中,女性患者补液速度小于男性患者;相对积极的液体治疗有助于改善早期AP患者的CRP,低补液速度组更易出现AP加重及肾功能不全,而高补液速度组更易出现心功能不全。Objective To investigate the impact of early fluid management on C-reactive protein(CRP)and the severity and progression in the patients with acute pancreatitis(AP).Methods We retrospectively analyzed 214 patients with various types of AP admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to October 2022.The patients′general information,CRP,fluid volume within 0-24 h and 24-48 h of admission were recorded.According to the average fluid replacement rate,the patients were divided into the low fluid replacement rate group and the high fluid replacement rate group.The main outcome measures were average length of hospital stay,the progression of AP after 1 week,new onset heart dysfunction,new onset kidney dysfunction and survival rate.The study was developed to analyze the impact of different fluid replacement rates on CRP and the severity and progression during early period(0-24 h and 24-48 h).Results The average fluid replacement rate of AP patients was 29.6 mL/(kg·24 h).During the first 24 h of hospitalization and the subsequent 24-48 h,the proportion of females was significantly higher than that of males in the low fluid replacement rate group[<29.6 mL/(kg·24 h)](P<0.05).During the first 24 h of hospitalization,the low fluid replacement rate group has higher CRP levels on the third,fifth and seventh day compared to the high fluid replacement rate group(Z=-2.659,-2.541,-2.191,all P<0.05).Similarly,during the subsequent 24-48 h of hospitalization,the low fluid replacement rate group has higher CRP levels on the first,third and fifth day compared to the high fluid replacement rate group(Z=-2.121,-2.288,-2.208,all P<0.05).The average time of hospitalization in the high and low fluid replacement rate group was(8.60±4.17)d and(9.01±4.21)d,there was no statistical significance between the two groups.1 week after admission,the severity of AP in the patients was re-evaluated,and a total of 15 patients appeared the aggravated symptoms including six people in the high flu

关 键 词：液体管理 C-反应蛋白 轻症胰腺炎 重症胰腺炎 心功能不全 肾功能不全 

分 类 号：R576[医药卫生—消化系统]