肺部超声B线评分对重症急性胰腺炎患者早期液体复苏的指导作用及预后影响  

The guiding effect of lung ultrasound B-line score on early fluid resuscitation and prognosis in patients with severe acute pancreatitis

作　　者：张婷 邹帅[2] 陈钇然[2] 陈红伟 ZHANG Ting;ZOU Shuai;CHEN Yi-ran;CHEN Hong-wei(The Fourth Clinical College,Xinxiang Medical University,Xinxiang 453000,Henan;Department of Critical Care Medicine,the Fifth People's Hospital of Chongqing,Chongqing 400062;Department of Emergency,Xinxiang Central Hospital,Xinxiang 453000,Henan,China)

机构地区：[1]新乡医学院第四临床学院,河南新乡453000 [2]重庆市第五人民医院重症医学科,重庆400062 [3]新乡市中心医院急诊科,河南新乡453000

出　　处：《川北医学院学报》2025年第3期327-330,共4页Journal of North Sichuan Medical College

基　　金：河南省医学科技攻关计划项目(LHGJ20210907)。

摘　　要：目的:探讨肺部超声B线评分对重症急性胰腺炎(SAP)患者早期液体复苏的指导作用及预后影响。方法:将90例SAP患者按照液体管理方式的不同分为对照组(n=45)和观察组(n=45)。两组患者均以早期目标导向治疗(EGDT)策略指导正向液体治疗,对照组以肺部啰音增加及氧饱和度下降作为反向液体复苏的标志;观察组采用肺部超声B线评分指导液体管理。比较两组初始6 h、第1天、第2天及48 h合计液体平衡量;比较两组入组0、6、12、24 h组织灌注及氧代谢指标[氧合指数(PaO_(2)/FiO_(2))、血乳酸及中心静脉血氧饱和度(ScvO_(2))];比较两组入组时、治疗24及48 h B型脑钠肽(BNP)及腹腔内压力(IAP)水平,并比较两组终点事件[6 h复苏达标率、多器官功能障碍综合征(MODS)发生率及病死率]。结果:观察组患者初始6 h、第1天、第2天及前48 h合计液体平衡量均少于对照组患者(P<0.05)。两组患者PaO_(2)/FiO_(2)及血乳酸随时间下降,且复苏后各时间点观察组PaO_(2)/FiO_(2)更高(P<0.05);血乳酸更低(P<0.05);两组患者ScvO_(2)随时间上升,且观察组在复苏24 h时更高(P<0.05)。两组患者BNP及IAP随时间上升,且复苏后各时间点观察组更低(P<0.05)。观察组患者6 h复苏达标率高于对照组(P<0.05),MODS发生率低于对照组(P<0.05);28 d病死率观察组患者与对照组患者比较,差异无统计学意义(P>0.05)。结论:肺部超声B线评分指导SAP患者早期液体复苏具有较高临床价值,其有助于及时调整液体复苏量,降低容量过负荷风险,改善患者整体预后。Objective:To investigate the effect of pulmonary ultrasound B-line score on the guidance and prognosis of early fluid resuscitation in patients with severe acute pancreatitis(SAP).Methods:90 patients with SAP were divided into control group(n=45) and observation group(n=45) according to the different ways of fluid management.Both groups received positive fluid therapy guided by the EGDT strategy.The control group used increased lung rales and oxygen desaturation as a sign of reverse fluid resuscitation,while the observation group used lung ultrasound B-line score to guide fluid management.The total liquid balance was compared between the two groups at the initial 6 h,1 d,2 d and 48 h.The tissue perfusion and oxygen metabolism indexes [oxygenation index(PaO_(2)/FiO_(2)),blood lactate and central venous oxygen saturation(ScvO_(2))] were compared between the two groups at 0,6,12 and 24 h.The levels of B-type natriuretic peptide(BNP) and intra-abdominal pressure(IAP) were compared between the two groups at the time of enrollment,24 and 48 h after treatment,and the endpoint events [6 h resuscitation compliance rate,incidence of multiple organ dysfunction syndrome(MODS) and mortality] were compared between the two groups.Results:The total amount of fluid balance in the observation group was less than that in the control group at the initial 6 h,1 d,2 d and the first 48 h(P<0.05).The PaO_(2)/FiO_(2) and blood lactate in the two groups decreased with time,and PaO_(2)/FiO_(2) in the observation group was higher at each time point after resuscitation(P<0.05),blood lactate was lower(P<0.05),the ScvO_(2) of the two groups increased with time,and the observation group was higher at 24 h of resuscitation(P<0.05).BNP and IAP levels in both groups increased over time,and the observation group was lower at each time point after resuscitation(P<0.05).The 6-hour resuscitation compliance rate in the observation group was higher than that in the control group,and the incidence of MODS was lower than that in the control group(P<0.05).

关 键 词：重症急性胰腺炎 早期液体复苏 肺部超声 B线评分 微循环 

分 类 号：R657.51[医药卫生—外科学]