28例胰腺相关腹腔大出血患者液体治疗回顾

Fluid therapy for pancreas-related massive abdominal bleeding in 28 patients

目的研究肝胆外科与胰腺相关的腹腔大出血患者液体治疗。方法选取我院肝胆外科监护室2008年6月-2010年7月收治的与胰腺相关腹腔出血患者28例,失血量约2 000-3 000ml。患者经手术或非手术治疗止血后进入ICU时作为液体治疗起点。治疗分两阶段,第一阶段为实现平均动脉压(MAP)≥65mmHg(1mmHg=0.133kPa)、血红蛋白(Hb)≥80g/L、尿量0.5-1ml/(kg.h),可停用升压药物;第二阶段为实现血流动力学平稳,并避免组织间液回吸收引发的心衰和肺水肿。记录两阶段液体复苏过程和血流动力学、血气分析和血液生化等指标变化。结果第一阶段(16.2±8.3)h,第二阶段(51.3±16.7)h。第一阶段补液量和输注的血液制品较第二阶段多。第二阶段尿量增加,凝血功能明显改善(P<0.05)。26例患者治愈,2例死亡(均为难治性感染并多脏器功能衰竭)。结论与胰腺相关的腹腔大出血患者液体治疗应分阶段进行。

Objective To study the fluid therapy for pancreas-related massive abdominal bleeding.Methods Twenty-eight patients with pancreas-related massive abdominal bleeding admitted to our department from June 2008 to July 2010 were enrolled in this study.The total blood loss in them was approximately 2 000-3 000ml.The patients received fluid therapy at the time when they were sent to the ICU after their bleeding was controlled with surgical or non-surgical methods.The therapy was divided into two stages.When the mean arterial pressure was≥65mmHg,hemoglobin（Hb） was≥80g/L,and urine volume was 0.5-1ml/（kg·h） after the first stage therapy,blood pressure-elevating drugs were withdrawn.The second stage therapy was to achieve stable hemodynamics in order to prevent heart failure and pulmonary edema due to the absorption of interstitial fluid.The resuscitation,hemodynamics,blood gas analysis results and blood biochemical indexes were recorded.Results The time of the first and second stage therapy was 16.2±8.3h and 51.3±16.7h,respectively.The amounts of fluid infusion and blood transfusion were higher in the first stage therapy than in the second stage therapy（P0.05）.The urine output and coagulation function were much more improved after the second stage therapy than after the first stage therapy（P0.05）.Of the 28 patients,26 were cured and 2 died of severe infection and multiple organ failure.Conclusion Fluid therapy should be divided into different stages for pancreas-related massive abdominal bleeding.