低晶胶比液体复苏完成时限对成人重症急性胰腺炎休克患者病情及转归的影响  

Effect of completion time for low crystalloid-to-colloid ratio fluid resuscitation on disease condition and outcome of adult patients with severe acute pancreatitis complicated with shock

作　　者：荣曾霞 熊绘 杨勋能[1] RONG Zengxia;XIONG Hui;YANG Xunneng(Department of Emergency,Zigong Third People's Hospital in Sichuan Province,Zigong,Sichuan,643020;Internal Department of Cardiovascular Medicine,Zigong Third People's Hospital in Sichuan Province,Zigong,Sichuan,643020)

机构地区：[1]四川省自贡市第三人民医院急诊科,四川自贡643020 [2]四川省自贡市第三人民医院心血管内科,四川自贡643020

出　　处：《实用临床医药杂志》2024年第23期81-86,共6页Journal of Clinical Medicine in Practice

基　　金：2021年四川省医学(青年创新)科研项目(S21618)。

摘　　要：目的探讨不同低晶胶比液体复苏完成时限在成人重症急性胰腺炎休克中的应用效果。方法回顾性选取本院2021年5月—2024年4月收治的119例重症急性胰腺炎休克患者为研究对象,入院后均行低晶胶比液体复苏,并依据复苏完成时限分为≤1 h组(n=42)、>1~2 h组(n=40)、>2 h组(n=37)。比较3组复苏前后中心静脉压(CVP)、平均动脉压(MAP)、心指数、动脉血二氧化碳分压[p_(a)(CO_(2))]、pH值、动脉血氧分压[p_(a)(O_(2))]、血乳酸、肺血管通透性指数(PVPI)、血管外肺水指数(ELWI)以及呼吸支持、去甲肾上腺素剂量、液体复苏量、ICU住院时间、生存率、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分、序贯脏器衰竭(SOFA)评分。结果与>2 h组比较,≤1 h组、>1~2 h组复苏后MAP、CVP、心指数升高,差异有统计学意义(P<0.05);与复苏前相比,复苏后3组p_(a)(O_(2))均升高,p_(a)(CO_(2))、血乳酸、pH值均降低,差异有统计学意义(P<0.05);复苏后≤1 h组和>1~2 h组血乳酸、去甲肾上腺素剂量、APACHEⅡ评分、SOFA评分均较>2 h组降低,差异有统计学意义(P<0.05);≤1 h组、>1~2 h组、>2 h组液体复苏量呈下降趋势,差异有统计学意义(P<0.05);≤1 h组有创呼吸支持患者比率及ICU住院时间较>1~2 h组和>2 h组更高更长,差异有统计学意义(P<0.05);复苏后≤1 h组ELWI、PVPI较复苏前升高,差异有统计学意义(P<0.05);复苏后≤1 h组ELWI、PVPI高于>1~2 h组、>2 h组,差异有统计学意义(P<0.05);≤1 h组、>1~2 h组、>2 h组30 d生存率分别为85.71%(36/42)、97.50%(39/40)、97.30%(36/37),>1~2 h组和>2 h组30 d生存率高于≤1 h组,差异有统计学意义(P<0.05)。结论低晶胶比液体复苏>1~2 h为重症急性胰腺炎患者最佳完成时限,更有利于改善患者血流动力学、动脉血气指标,促进患者病情转归。Objective To explore the application effects of different completion time for low crystalloid-to-colloid ratio fluid resuscitation in treatment of adult patients with severe acute pancreatitis complicated with shock.Methods A retrospective analysis was conducted in 119 patients with severe acute pancreatitis complicated with shock in the hospital from May 2021 to April 2024.All the patients underwent low crystalloid-to-colloid ratio fluid resuscitation and were divided into≤1 h group(n=42),>1 to 2 h group(n=40),and>2 h group(n=37)based on the completion time of resuscitation.Differences were compared among the three groups in terms of central venous pressure(CVP),mean arterial pressure(MAP),cardiac index,arterial partial pressure of carbon dioxide[p_(a)(CO_(2))],pH value,arterial partial pressure of oxygen[p_(a)(O_(2))],blood lactate,pulmonary vascular permeability index(PVPI),extravascular lung water index(ELWI)as well as respiratory support,dose of norepinephrine,fluid resuscitation volume,length of stay in ICU,survival rate,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,and Sequential Organ Failure Assessment(SOFA)score before and after resuscitation.Results Compared with the>2 h group,the MAP,CVP and cardiac index increased significantly in the≤1 h group and the>1 to 2 h group after resuscitation(P<0.05);compared with pre-resuscitation,the p_(a)(O_(2))increased significantly while the p_(a)(CO_(2)),blood lactate and pH values decreased significantly in all the three groups after resuscitation(P<0.05);after resuscitation,the blood lactate,dose of norepinephrine,APACHEⅡ score,and SOFA score were significantly lower in the≤1 h group and the>1 to 2 h group when compared with the>2 h group(P<0.05);there was a decreasing trend in fluid resuscitation volume among the≤1 h group,>1 to 2 h group,and>2 h group,with significant between-group differences(P<0.05);the rate of patients requiring invasive respiratory support and length of stay in ICU in the≤1 h group were significantly high

关 键 词：重症急性胰腺炎 休克 低晶胶比液体复苏 完成时限 病情转归 

分 类 号：R657.5[医药卫生—外科学] R654.1[医药卫生—临床医学] R441.9