B型尿钠肽在重症急性胰腺炎患者液体复苏中的临床意义

The clinical significance of B-type natriuretic peptide in the process of fluid resuscitation in the patients with severe acute pancreatitis

目的探讨B型尿钠肽(BNP)在重症急性胰腺炎(SAP)患者液体复苏过程中的临床意义,用以指导临床补液。方法回顾性分析重庆市急救中心2010年1月至2012年12月收治的85例SAP患者的临床资料,以晶胶比3∶1为界,将患者分为低晶胶比组(45例)和高晶胶比组(40例),以早期目标导向治疗为复苏终点,观察液体复苏前及复苏后1、2、3d及出院前1dBNP的变化。结果不同晶胶比的液体复苏均可改善患者血流动力学,BNP随复苏液体总量的增加而增加,与液体量呈正相关;与高晶胶比组相比,低晶胶比组所需液体量明显减少。结论对SAP患者宜监测血浆BNP以指导液体复苏,且宜采用提高胶体比例的限制性液体复苏策略。

Objective To investigate the clinical significance of B-type natriuretic peptide（BNP） in the process of fluid resuscita- tion with different crystalloid-eolloid ratio in the patients with severe acute pancreatitis（SAP）. Methods Clinical data of 85 SAP patients were analyzed retrospectively in the Emergency Center of Chongqing during January of 2010 to December of 2012. Early goal-directed therapy（EGDT） was confirmed the end criterion of the end point of resuscitation. Low crystalloid-colloid ratio group （n=45） and high crystalloid-colloid ratio group（n=40） were divided according to crystalloid-colloid ratio（3 ： 1） as the borderline, BNP were observed at the time point of before fluid resuscitation,and 1,2,3 days after resuscitation and the day before discharge. Results Different fluid resuscitation of crystalloid-colloid ratio could improve hemodynamics in patients,BNP increased with the to- tal amount of resuscitation liquid,were positively correlated with liquid volume. The total amount of fluid of the high crystalloid- colloid ratio group was significantly higher than that of the low crystalloid-eolloid ratio group. Conclusion BNP could guide early fluid resuscitation and low crystalloid-colloid ratio should be adopted for SAP patients.