不同速率早期液体复苏对初始评估未达重症标准急性胰腺炎血流动力学及预后的影响

Comparison of effects of early fluid resuscitation at different rates on hemodynamics and prognosis of initially assessed non-severe acute pancreatitis

目的:探讨不同速率早期液体复苏在初始评估未达重症标准急性胰腺炎(NSAP)患者中的应用效果.方法:回顾性分析336例初始评估NSAP患者临床资料,按照早期补液速率将患者分为高速率补液组191例(24 h液体复苏总量>入院后48 h液体复苏总量1/2)和低速率补液组145例(24 h液体复苏总量≤入院后48 h液体复苏总量1/2).记录两组患者入院后24 h、48 h、72 h补液总量,比较入院后12 h、48 h、72 h、7 d时外周血生化指标[C反应蛋白(CRP)、红细胞压积(HCT)、血肌酐(Cre)]水平变化,分析两组患者预后情况.结果:入院后24 h、48 h高速率补液组患者补液总量显著高于低速率补液组,高速率补液组入院后12 h CRP、HCT水平及入院后72 h CRP水平、生命体征达标时间、全身炎症反应综合征(SIRS)发生率、多器官功能障碍综合征(MODS)发生率、有创(介入)操作率、机械通气率、重症监护治疗率、转化为重症率均显著低于低速率补液组.结论:高速率补液有利于改善初始评估未达NSAP患者血流动力学及预后,有较高临床应用价值.

Objective To investigate the application effects of different rates of early fluid resuscitation on patients with non-severe acute pancreatitis(NSAP)at initial assessment.Methods The clinical data of 336 patients with NSAP at initial assessment were retrospectively analyzed.According to the early fluid infusion rate,the patients were divided into high-rate fluid infusion group(191 cases,total fluid resuscitation at 24 h>1/2 of total fluid resuscitation at 48 h after admission)and low-rate fluid infusion group(145 cases,total fluid resuscitation at 24 h≤1/2 of total fluid resuscitation at 48 h after admission).The total fluid infusion at 24 h,48 h and 72 h after admission was recorded in the two groups,and the changes in peripheral blood biochemical indicators[C-reactive protein(CRP),hematocrit(HCT),serum creatinine(Cre)]were compared at 12 h,48 h,72 h,and 7 d after admission.The prognosis were analyzed in the two groups of patients.Results The total fluid infusion at 24 h and 48 h after admission in high-rate fluid infusion group was significantly higher than that in low-rate fluid infusion group(P<0.05),and the CRP and HCT levels at 12 h after admission and CRP level at 72 h after admission,time of vital signs reaching the standard,incidence rate of systemic inflammatory response syndrome(SIRS),incidence rate of multiple organ dysfunction syndrome(MODS),rate of invasive(interventional)operation,mechanical ventilation rate,rate of intensive care treatment and rate of conversion to severe condition were significantly lower than those in low-rate fluid infusion group(P<0.05).Conclusion High-rate fluid infusion is beneficial to improving the hemodynamics and prognosis of patients with NSAP at initial assessment,with high clinical application value.