重症急性胰腺炎早期强化液体复苏治疗30例临床观察

Clinical observation on the effect of intensive early fluid resuscitation in 30 cases of severe acute pancreatitis

目的探讨重症急性胰腺炎（SAP）患者急性反应期液体复苏治疗的方法及效果。方法选取2008年8月至2010年3月收治的58例SAP患者,按治疗方法分为2组,治疗组30例SAP患者采用强化液体复苏,应用羟乙基淀粉并增加胶体液输入,也可临时加用少量血浆或白蛋白,晶体采用生理盐水和/或平衡盐液,晶胶液体比例2∶1-1∶1;对照组28例给予补充有效循环血量,纠正水电解质失衡等,每日输入一定量的血浆或白蛋白。对SAP患者在急性反应期出现呼吸衰竭、肾功能不全、心功能不全等指标进行比较。结果 2组患者急性反应期治疗过程中并发症比较,治疗组呼吸衰竭、肾功能不全、心功能不全等并发症均明显低于对照组,差异有统计学意义（P〈0.05）;2组患者急性反应期每日液体输入量比较,治疗组液体输入量明显低于对照组,差异有统计学意义（P〈0.05）。结论 SAP患者急性反应期采用积极有效的液体复苏可降低各种并发症,补充羟乙基淀粉并提高胶体液比例,可取得更好的复苏效果。

Objective To investigate the treatment method and effect of intensive early fluid resuscitation on the patients with severe acute pancreatitis（ SAP） in acute reaction stage. Methods Fifty-eight patients with SAP treated in the hospital from Aug.2008 to Mar. 2010 were randomly divided into the treatment group（ n = 30） and the control group（ n = 28）. The patients in the former group were given intensive early fluid resuscitation,either with hydroxyethylstarch and an increased amount of colloidal fluid or occasionally with a certain amount of plasma and albumin. Physiological saline and / or balanced salt solution were used as crystal fluid,with a ratio of 1∶ 2- 1∶ 1. The patients in the latter group were supplemented or treated with an effective circulating blood volume and electrolyte imbalance correction. They were daily infused with a certain amount of plasma and albumin. Analyses were made on such reactions as respiratory failure,renal insufficiency and cardiac dysfunction in the acute reaction stage in patients with SAP. Results With regard to the incidence of complications during the acute reaction stage for the patients of the 2 groups,the incidence of respiratory failure,renal insufficiency and cardiac dysfunction in the patients of the treatment group was significantly lower than that in the patients of the control group,with statistical significance（ P〈0. 05）. With regard to the amount of daily fluid infusion for the groups during the acute reaction stage,the amount of infusion for the treatment group was significantly lower than that for the control group,with statistical significance（ P〈0. 05）. Conclusion Effective and active early fluid resuscitation during the acute reaction stage in SAP patients could decrease the incidence of complications. The supplementation of Hydroxyethylstarch and the increase in the ratio of colloidal fluid could produce better resuscitative effects on patients with SAP.