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目的:探讨重症急性胰腺炎(SAP)急性反应期液体复苏治疗的经验。方法:回顾性分析我院1 998年6月～2008年8月收治的资料完整的127例SAP,将病人分为死亡组(32例)和治愈组(95例)。比较2组发病急性反应期血流动力学变化,分析液体复苏参数及其对预后的影响。结果:2组病例入院时均呈休克或休克前期状态,但死亡组的低平均动脉压、低中心静脉压(CVP)、尿量少和高红细胞压积(HCT)状态均较治愈组持续时间明显延长(P<0.05)。入院72 h内2组总液体静脉输入量无显著差异(P>0.05),但治愈组输入的胶体与晶体总量及比值,以及输液速度均较死亡组显著升高(P<0.05);2组的APACHEⅡ评分在入院第1天和第2天无差异(P>0.05),而在第3天死亡组的1 8.21±6.20,明显高于治愈组的15.78±4.31,两者有统计学差异(P<0.05);在发病14 d内,死亡组的MODS发生率为和累计器官功能障碍个数分别为100%和3.21±0.41,而治愈组的这两项指标分别为43.1 6%和2.56±0.37,有统计学差异(P<0.05)。死亡组呼吸机使用率、CRRT使用率和ACS发生率显著高于治愈组(P<0.05):死亡组ICU滞留时间为19±5 d,明显较治愈组(14±4 d)延长(P<0.05)。结论:液体复苏治疗是维持重症急性胰腺炎急性反应期血流动力学稳定的基础,必须强调胶体和晶体合理的比例及输注速度。
Objective: To investigate the experience of liquid resuscitation in acute response to severe acute pancreatitis (SAP). Methods: A total of 127 SAP patients with complete data from June 1998 to August 2008 in our hospital were retrospectively analyzed. Patients were divided into death group (32 cases) and cured group (95 cases). The hemodynamic changes in acute onset of the two groups were compared, and the parameters of fluid resuscitation and their effects on prognosis were analyzed. Results: All the patients in the two groups showed shock or pre-shock state at admission, but the mean arterial pressure, CVP, urine volume and HCT in the death group were significantly lower than those in the cured group Significantly longer (P <0.05). There was no significant difference in total intravenous infusion between the two groups within 72 hours after admission (P> 0.05). However, the total amount and ratio of colloid and crystals, as well as infusion rate in the cured group were significantly higher than those in the death group (P <0.05). 2 The APACHEⅡscore of the group had no difference on the first day and the second day of admission (P> 0.05), while on the third day, the value of 1 8.21 ± 6.20 was significantly higher than that of the cure group (15.78 ± 4.31) (P <0.05). Within 14 days after onset, the incidence of MODS and cumulative organ dysfunction in the death group were 100% and 3.21 ± 0.41 respectively, while those in the cured group were 43.1% and 2.56% respectively ± 0.37, with statistical significance (P <0.05). Respiratory rate, CRRT use rate and ACS incidence in death group were significantly higher than those in the cured group (P <0.05). The retention time of ICU in the death group was 19 ± 5 days, significantly longer than that of the cured group (14 ± 4 days) (P < 0.05). Conclusion: Fluid resuscitation therapy is the basis of maintaining hemodynamic stability in severe acute pancreatitis. It is necessary to emphasize the reasonable proportion of colloid and crystal and the infusion rate.