重症急性胰腺炎早期液体复苏方案初探

Strategy of fluid resuscitation in the early stage of severe acute pancreatitis： a report of 60 cases

目的探讨重症急性胰腺炎（SAP）早期液体复苏的合理方案。方法收集我院2005年3月至2007年9月收治的60例SAP患者，根据每日复苏液中晶体和胶体的不同用量，随机分为晶体组、晶胶联合I组（晶：胶=4：1）、晶胶联合Ⅱ组（晶：胶=3：1）和晶胶联合Ⅲ组（晶：胶=2：1），各15例。观察患者血细胞比容（HCT）、中心静脉血氧饱和度（ScvO2）、胃黏膜pH值（pHi）、血乳酸、液体负平衡出现时间、液体扣押量、病死率及多器官功能不全综合征（MODS）发生率等指标。结果联合应用晶、胶体进行液体复苏较单纯晶体组显著改善SAP的各项指标（P〈0．05），以晶胶联合Ⅲ组改善效果最佳。该组患者的HCT为（30．3±7．1）％、ScvO2为（81．1±16．2）％、pHi7．8±1．5、血乳酸（1．4±0．6）mmol／L、液体负平衡出现时间为（77．0±16．8）h、液体扣押量（50．2±7．8）ml、病死率6．7％、MODS发生率20％，与晶体组、联合Ⅰ组、联合Ⅱ组比较均有显著差异（P〈0．05）。结论SAP早期联合应用晶、胶体液进行液体复苏可有效恢复循环血容量、减轻液体扣押量、缩短正平衡持续时间、增加组织灌注和氧供、维护重要脏器功能，从而显著改善SAP的预后。

Objective To investigate the optimal strategy of fluid resuscitation in the early stage of severe acute pancreatitis （SAP）. Methods 60 SAP patients who received treatment in our hospital from March, 2005 to september, 2007 were randomly divided into 4 groups （n = 15） according to the different amounts of crystal and colloid in the daily resuscitation, including crystal group, combined group [ （the ratio of crystal to colloid was 4 to 1 ）, combined group Ⅱ （ the ratio was 3 to 1 ） and combined group m （ the ratio was 2 to 1 ）. The levels of hematocrit （HCT） , saturation of central vein oxygen （ScvO2 ） , gastric mucosa pH （pHi） , serum lactic acid as well as the advent of negative fluid balance, the amount of fluid contained in the third space, mortality rate and the incidence of multiple organ dysfunction syndrome （MODS） in different groups were compared. Results Compared with crystal group, all the parameters were significantly improved in the 3 combined groups （ P 〈 0.05 ） and the strategy in combined group Ⅲ seemed to be the most effective. HCT in this group of patients was （30.3 ±7.1） %, ScvO2 was（81.1 ± 16.2）%, phi was 7.8 ± 1.5, lactic acid was （ 1.4 ± 0.6） mmol/L, the advent of negative fluid balance was （77.0 ± 16.8） h, the amount of fluid contained in the third space was（50.2 ± 7.8）ml, mortality rate was 6.7% and MODS incidence was 20%. Conclusions In the early stage of SAP, fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space, shorten the duration of positive fluid balance, increase tissue perfusion and oxygen supply, maintain critical organs＇ function and significantly improve the prognosis of SAP.