不同液体复苏对重症急性胰腺炎患者预后的影响分析

An analysis of the effect of different ways of fluid resuscitation on the prognosis of patients with severe acute pancreatitis

目的探讨不同液体复苏对重症急性胰腺炎患者预后的影响。方法回顾性分析2009年3月-2012年10月我院SICU 172例重症急性胰腺炎患者的临床资料,根据患者入院后24h内液体复苏量将患者分成A组与B组,各86例。A患者给予充分性液体复苏治疗,B组患者给予限制性液体复苏治疗,比较两组患者的临床治疗效果和预后。结果 A组患者的急性肾损伤（AKI）发生率、AKI持续时间、肌酐峰值及连续肾脏替代疗法（CRRT）使用率均较B组有明显升高,两组比较具有统计学意义（P〈0.05）;A组患者与B组患者在多器官功能衰竭综合征（MODS）发生率、CRRT使用时间、机械通气率、开腹手术率、住院时间及死亡率等方面无统计学意义（P〉0.05）。结论对于重症急性胰腺炎患者给予限制性液体复苏能够显著降低患者的AKI发生率和持续时间以及肌酐峰值,减少CRRT的使用率,减少并发症的发生,较充分性液体复苏具有更好的临床疗效,对于重症胰腺炎患者疾病的治疗和预后具有重要的意义。

Objective To explore the effect of different ways of fluid resuscitation on the prognosis of patients with severe acute pancreatitis. Methods Clinical data of 172 patients with severe acute pancreatitis who were admitted to our hospital from March 2009 to October 2012 were retrospectively analyzed. They were allocated to two groups, group A and group B, according to the amount of fluid resuscitation within 24 hours after admission, with 86 patients in each group. Patients in group A received the treatment of aggressive fluid resuscitation, and the patients in group B received the treatment of limited fluid resuscitation. Clinical efficacy and prognosis were compared between the two groups. Results Incidence of AKI, duration of AKI, peak value of creatinine and application rate of CRRT in group A were all significantly higher or longer than those in group B, and the differences were statistically significant（P〈0.05）; differences of incidence of MODS, application time of CRRT, mechanical ventilation rate, laparotomy rate, hospitalization time and mortality rate between the two groups were not statistically significant（P〉0.05）. Conclusion For patients with severe acute pancreatitis, limited fluid resuscitation helps significantly reduce the incidence and duration of AKI and peak value of creatinine, lower the application rate of CRRT and prevent complications, which has a better clinical efficacy than that of aggressive fluid resuscitation and is of great significance in the treatment and prognosis for patients with severe pancreatitis.