限制性液体复苏对重症急性胰腺炎患者预后的影响

Effects of limited fluid resuscitation on the prognosis of patients with severe acute pancreatitis

目的探讨限制性液体复苏对重症急性胰腺炎患者治疗和转归的影响。方法回顾性分析安徽医科大学第一附属医院重症医学科2012年1月至2015年12月收治的44例重症急性胰腺炎患者的临床资料,分为早期单纯液体复苏组(对照组)和限制性液体复苏组(研究组),比较两种液体复苏方式对重症急性胰腺炎患者治疗和预后的影响。结果与对照组相比,研究组复苏24 h平均动脉压偏低(65.32±15.23 mm Hg比77.43±13.86 mm Hg,P=0.041),24小时尿量偏少(1448.89±154.13 ml比1600.74±138.37 ml,P=0.008);使用血管活性药物的患者比例(40.00%比25.00%,P=0.446)和血乳酸水平(4.51±1.09 mmol/L比4.34±1.58 mmol/L,P=0.946)较高,6小时和24小时复苏达标率偏低(55.00%比62.50%,P=0.798;80.00%比87.50%,P=0.842),但无统计学差异;住ICU时间明显缩短(9.5±10.75天比11.75±5.52天,P=0.045),有创机械通气率较低(30.00%比87.50%,P=0.049);AKI发生率(55.00%比50.00%,P=0.853)、ACS发生率(45.00%比66.67%,P=0.444)、MODS发生率(20.00%比16.67%,P=0.812)、腹腔穿刺引流率(60.00%比54.17%,P=0.839)和死亡率(15.00%比16.67%,P=0.812)两组比较无统计学差异。结论早期限制性液体复苏措施能够缩短重症急性胰腺炎患者的住ICU时间,降低有创机械通气治疗风险,但并不影响死亡率。

Objective To explore the effect of different ways of fluid resuscitation on the prognosis of patients with severe acute pancreatitis. Methods The clinical data of 44 patients with severe acute pancreatitis( SAP) in our hospital were analyzed retrospectively from January 2012 to December 2015. They were allocated to two groups,control group( 24 cases) and research group( 20cases),according to the amount of fluid resuscitation within 24 hours after admission. Patients in control group received the treatment of simple fluid resuscitation,and the patients in research group received the treatment of limited fluid resuscitation. Clinical data and prognosis were compared between the two groups. Results In the research group,24 hours mean arterial pressure( MAP) was lower( 65. 32 ± 15. 23 mm Hg vs 77. 43 ± 13. 86 mm Hg,P = 0. 041) and 24 hours urine volume was less( 1448. 89 ± 154. 13 ml vs1600. 74 ± 138. 37 ml,P = 0. 008). There was no significant difference in the percentage of the use of vasoactive drugs,in the blood lactic acid and in the recovery efficiency within 6h and within 24 h between the two groups. The length of ICU stay was shortened( days: 9. 5 ± 10. 75 vs 11. 75 ± 5. 52,P = 0. 045) and the incidence of invasive mechanical ventilation was lower( 30. 00% vs87. 50%,P = 0. 049). The incidence of AKI,ACS and MODS between the two groups were not statistically significant difference. The mortality( 16. 67% vs 20. 00%,P = 0. 812) in the two groups was no statistical difference. Conclusion The limited fluid resuscitation may be helpful in shortening length of ICU stay,and did not increase the risk of invasive mechanical ventilation,but there was no obvious change in mortality rate.