晶体、胶体体液复苏对重症急性胰腺炎患者血流动力学的影响

Effect of crystal and colloid fluid resuscitation on hemodynamics in patients with severe acute pancreatitis

目的探究并分析晶体、胶体体液复苏对重症急性胰腺炎患者血流动力学的影响。方法选取2012年1月至2015年6月收治的100例重症急性胰腺炎患者,按照随机数字表法将其分为观察组和对照组,每组50例。观察组给予6%羟乙基淀粉130/0.4溶液+0.9%氯化钠溶液复苏,对照组给予0.9%氯化钠溶液复苏。观察并记录下两组患者复苏前、复苏24 h、复苏48 h的平均动脉压(MAP)、心率(HR)、氧合指数(PaO_2/FiO_2)、肺血管通透性指数(PVPI)、血管外肺水指数(EVLWI)、中心静脉压(CVP)以及所用液体量。结果经重复方差分析,两组患者MAP、HR、PaO2/FiO2不同时间点比较差异明显,随着治疗的进行,两组患者血流动力学均得到明显改善,差异具有统计学意义(P<0.05)。两组患者MAP、HR、PaO_2/FiO_2组间、组间不同时间点比较无显著差异(P>0.05)。两组患者PVPI、EVLWI、CVP多时间点比较差异明显,随着治疗的进行,两组患者PVPI、EVLWI、CVP均得到明显改善,差异具有统计学意义。两组患者PVPI、CVP组间、组间多时间点比较无显著差异(P>0.05),两组患者EVLWI组间、组间多时间点比较差异有显著性(P<0.05),两组患者液体使用量差异明显(P<0.05),观察组复苏48 h时液体使用总量明显低于对照组(P<0.05)。结论对于重症急性胰腺炎患者而言,无论是使用晶体液进行复苏还是胶体液进行复苏,均能有效改善患者血流动力学,且效果无显著差异。但液体中加入胶体后能有效减少患者输液总量,降低患者容量负荷。

Objective To explore and analyze the effect of crystal and colloid fluid resuscitation on hemodynamics in patients with severe acute pancreatitis. Methods 100 cases of severe acute pancreatitis were randomly divided into observation group and control group,50 cases in each group according to the random number table method,cases of severe acute pancreatitis in our hospital from June 2015 to January 2012. The observation group give 6% hydroxyethyl starch 130 /0. 4 0. 9% sodium chloride solution resuscitation,the control group were given 0. 9% sodium chloride solution resuscitation,the venous blood gas analysis results to adjust the amount of fluid,observe and record two groups of patients with map（ mean arterial pressure）,HR（ heart rate）,PaO_2/ FiO_2（ oxygen index） and PVpi（ pulmonary vascular permeability index）,EVLWI（ extravascular lung water index）,CVP（ central venous pressure） and volume of liquid. Results After repeated analysis of variance,MAP,HR,PaO2/ FiO_2,two groups were significantly improved,with statistical significance（ P〈0. 05）. There was no significant difference in HR,MAP and PaO_2/ FiO_2 between the two groups（ P〉0. 05）. CVP,PVPI,EVLWI,CVP were significantly improved,with statistical significance. There were no significant differences in EVLWI,CVP and PVPI between the two groups（ P〉0. 05）. In the two groups,the amount of liquid used was significantly different（ P〈0. 05）. The total amount of liquid used in the observation group was significantly lower than that of the control group（ P〈0. 05）. Conclusion For the patients with severe acute pancreatitis,the recovery of the liquid and the recovery of colloid solution can effectively improve the hemodynamics and the effect is not obvious. But after adding colloid can effectively reduce the total volume of patients,reduce the patient capacity load.