容量复苏后液体正负平衡对急性重症胰腺炎的影响

Effects of liquid positive and negative balance on severe acute pancreatitis after resuscitation

目的探讨容量复苏达标后液体正负平衡对急性重症胰腺炎(SAP)的影响。方法选择经持续肾替代治疗(CRRT)的SAP患者42例,根据复苏达标后48 h液体出入量分为正平衡组及负平衡组,记录并比较复苏达标后0 h、24 h、48 h血流动力学指标、血管外肺水指数(EVLWI)、肺血管通透性指数、氧合指数(PO2/FiO2)、膀胱压(IAP)、心室脑钠肽(BNP)、血乳酸及每24小时液体出入量、ICU住院日、机械通气时间、CRRT时间。结果负平衡组ICU住院日、机械通气时间较正平衡组缩短(t分别=2.04、2.26,P均<0.05)。CRRT时间差异无统计学意义(t=1.93,P>0.05)。容量复苏后24 h、48 h负平衡组EVLWI、IAP、血乳酸均低于正平衡组(t分别=4.00、4.43;2.13、2.90;3.03、3.68,P均<0.05),PO2/FiO2高于正平衡组(t分别=2.84、2.25,P均<0.05),BNP在48 h低于正平衡组(t=2.13,P<0.05)。结论 SAP容量复苏达标后宜采用适度液体负平衡策略。

Objective To investigate the effects of liquid positive and negative balance on severe acute pancreatitis （SAP） after resuscitation. Methods A total of 42 patients with SAP treated by continuous renal replacement therapy（CR-RT） were randomly divided into positive balance group and negative balance group according to liquid intake and output after 48 hours of resuscitation. The haemodynamic indexes, extravascular lung water index （EVLWI）, pulmonary vascular permeability index, oxygenation index（PO2/FiO2）, bladder pressure（ICP）, B-type natriuretic peptide（BNP）, blood lactic acid, liquid intake and output every 24 hours and the length of ICU stay, mechanical ventilation and CRRT were recorded and compared. Results Length of ICU stay, mechanical ventilation in negative balance group was shorter than those in the positive balance group （t=2.04,2.26,P〈0.05）. Length of CRRT was not statistically significant in the two groups （t=1.93,P〉0.05）. At 24 hours and 48 hours after resuscitation, EVLWI, ICP and blood lactic acid in negative balance group were significantly lower than those in the positive balance group（t=4.00,4.43,2.13, 2.90,3.03,3.68,P〈0.05）while PO2/FiO2 was significantly higher than that in the positive balance group （t=2.84,2.25,P〈0.05）. The BNP in negative balance group was significantly lower than that in the positive balance group at 48 hours （t=2.13,P〈0.05）. Conclusion It should take liquid negative balance for SAP after resuscitation to standard.