抗心衰治疗在重症急性胰腺炎中的作用评价

Effect of anti-heart failure in the treatment of severe acute pancreatitis

目的评价抗心衰治疗在重症急性胰腺炎中的作用。方法收集崇州市人民医院消化内科2011年10月-2012年10月收治的12例重症急性胰腺炎合并左心衰的患者作为研究组,评价早期抗心衰在重症急性胰腺炎治疗中的作用。早期抗心衰治疗措施包括:限制钠盐、严格控制液体滴速和液体总量、速尿推注和调整晶胶体比例等。对照组为崇州市人民医院2008年1月-2010年1月收治的10例重症急性胰腺炎合并左心衰,而未行早期抗心衰治疗的患者。结果 12例经早期抗心衰治疗的患者全部好转出院,其中3例并发胰腺假性囊肿,2例并发轻至中度肝肾功能损害;10例未经早期抗心衰治疗的患者,8例出现急性呼吸窘迫综合征(ARDS),行有创呼吸机治疗后,其中2例早期死于多器官功能衰竭,2例后期死于腹腔脓肿感染,存活的6例患者均并发胰腺假性囊肿,4例并发中度至重度肝肾功能不全。结论抗心衰在重症急性胰腺炎治疗中具有重要作用,可以延缓或消除ARDS,未重视或早期抗心衰治疗不及时,易导致ARDS,加重急性胰腺炎的并发症,使其病死率明显提高。

Objective To evaluate the effect of anti-heart failure treatment in severe acute pancreatitis （SAP）.Methods Twelve SAP patients with left heart failure who received treatment in our hospital from Oct.2011 to Oct.2012 were studied prospectively to evaluate the effect of anti-heart failure treatment in SAP.The early anti-heart failure treatments included limiting sodium chloride,strict control of the liquid drop speed and liquid amount,intravenous push furosemide and control of the proportion of crystalline colloidal.Ten SAP patients with left heart failure who received treatment in our hospital from Jan.2008 to Jan.2010 without getting early anti-heart failure treatment were as control group.Results Twelve SAP patients with left heart failure who received the early anti-heart failure treatment were discharged from hospital after recovery.Two cases of them occurred mild to moderate functional lesion of liver and kidney,3 cases of them occurred pseudo cyst of pancreas.In control group,8 cases of ARDS were griven invasive respiratory support,2 cases died of multiple organ failure and 2 cases died of abdominal abscess infection.The 6 survived patients occurred pseudo cyst of pancreas and 4 cases occurred moderate to severe functional lesion of liver and kidney.Conclusion Anti-heart failure treatment plays an important role in the treatment of SAP.Because it can delay or eliminate the arrival of ARDS.Failed to give sufficient attention to anti-heart failure treatment or not timely anti-heart failure treatment can easily lead to the appearance of ARDS,aggravate the complications of SAP,and increase the mortality of SAP.