重症急性胰腺炎体液隔离危害性的临床分析

The clinical analysis of fluid sequestration in severe acute pancreatitis

目的分析重症急性胰腺炎(severe acute pancreatitis,SAP)体液隔离的危害。方法回顾性分析我院1995年1月至2000年1月53例SAP临床资料。按治疗结果分为早期死亡、晚期死亡、治愈3个组;统计3组入院后的前3 d总出入量和体液隔离量以及治疗48 h前后红细胞压积(HCT)的变化;分析早期死亡和后期死亡的原因。结果早期死亡组和晚期死亡组体液隔离持续48 h以上,早期死亡组、晚期死亡组和治愈组在48 h体液隔离量分别为(10 078.3±1 616.2)ml(、6 124.4±1 081.1)ml和(4 719.7±1 397.7)ml,3组相比差异有统计学意义(P<0.05)。早期死亡6例,多与心脏骤停和呼吸衰竭有关;晚期死亡12例,多与感染有关。结论体液隔离的实质是细胞外液病理性再分布和细胞外液增加。体液隔离的危害在早期为组织间隙体液大量急性贮留导致细胞、组织肿胀,心和肺功能受到致命的影响,在晚期增加感染的机会。

Objective To analyse fluid sequestration in severe acute pancreatitis （SAP）. Methods A retrospective review was conducted of 53 patients with SAP between January 1995 and January 2000. According to the outcomes, the patients were divided into early death group, later death group and survival group. Fluid intake, fluid output and fluid sequestration were measured within initial 72 hours in the three groups. Results Fluid sequestration in the early death group and later death group lasted for 48 hours or more. The mean fluid sequestration within initial 48 hours in the three groups was （10 078.3± 1 616.2）ml, （6 124.45± 1081.1）ml and （4 719.7±1 397.7）ml, respectively. These changes were statistically different （ P〈0. 05）. Six patients died of cardiac arrest and respiratory failure in the early death group, and twelve died of infection in the later death group. Conclusions The essence of fluid sequestration is pathological redistribution of extracellular fluid and expanding of extracellular fluid volume. A large amount of fluid storages acutely in interstitial space causes cell swelling and tissue edema, and may result in fatal influence on cardiac and pulmonary function.