继发性腹膜炎术后液体平衡干预的可行性

Feasibility of postoperative intervention on fluid balance in patients with secondary peritonitis

目的:探讨继发性腹膜炎(SP)患者术后液体平衡干预的可行性。方法:回顾性分析2006年6月至2011年11月河南新乡市中心医院收治的109例SP患者的临床资料,分为轻症干预组(22例)、轻症对照组(56例)、重症干预组(12例)、重症对照组(19例)。干预组患者用3.5%高渗盐水及利尿剂对液体平衡进行干预:对照组按传统液体治疗方法以维持患者血流动力学稳定。比较血流动力学指标、出入量负平衡出现时间及病情严重程度评分。结果:轻症干预组和轻症对照组出现液体负平衡时间分别为(2.11±1.04)d和(1.99±1.73)d,两组比较,差异无统计学意义(P>0.05)。重症干预组和重症对照组出现液体负平衡量时间分别为术后(3.77±0.90)d和(4.78±1.09)d,两组比较,差异有统计学意义(P<0.05)。术后3 d,干预组APACHEⅡ评分较对照组降低(P<0.05)。结论:重症SP患者术后液体平衡干预是可行的,并使其早日出现液体负平衡,有益于预后。

Objective：To explore the feasibility of postoperative intervention on fluid balance in patients with secondary peritonitis （SP）. Methods： We did a retrospective analysis on 109 patients with SP who were admitted to the department of general surgery, Xinxiang Central Hospital between June 2006 and March 2011. Patients were allocated to mile SP control group, mild SP intervention group, severe SP control group and severe SP intervention group. Patients in mild or severe intervention groups were subject to 3.5% hypertonic saline and diuretic therapy whilst those in mild or severe control group to maintenance of hemodynamics. This allowed comparison on the hemodynamies, the time point at which negative fluid balance occurred and APACHE Ⅱ scores. Results： There was no remarkable difference in the time point at which negative fluid balance was achieved [ （2.11 ± 1.04） days vs. （ 1.99 ±1.73 ） days, P 〉 0. 05 ]. Compared with severe SP control group, the severe SP intervention group was associated with a significantly shortened duration to onset of negative fluid balance [ （3.77 ±0.90） days vs. （4.78 ± 1.09） days, P 〈 0.051. Both intervention groups yielded a lower APACHE Ⅱ score at day 3 compared with control groups （ both P 〈 0. 05 ）. Conclusion ： The intervention of fluid balance is feasible for SP as a result of shortened duration to onset of negative fluid balance that is associated with improved prognosis.