高容量血液滤过下液体平衡对急性重症胰腺炎早期腹内压力的影响

The impact of fluid balance undergoing high volume hemofiltration on intra-abdominal pressure in patients with sever acute pancreatitis in the early stage treatment

目的分析高容量血液滤过(HVHF)对急性重症胰腺炎早期的患者进行干预后液体平衡的结果,探讨其对腹内压力(IAP)的影响。方法回顾性分析本院2013年8月至2015年l2月SICU 66例急性重症胰腺炎的临床资料,其中33例患者在发病早期进行HVHF为实验组,另33例发病早期未进行HVHF为对照组,液体治疗以早期目标导向性治疗(EDGT)方案进行管理,统计分析各组的一般情况、液体平衡量及腹腔压力情况。结果 1实验组和对照组72小时液体平衡量均为正平衡,分别为(6 230士1 250 ml、10 806士2 100)ml,组间比较差异有统计学意义(P<0.01);2实验组和对照组液体治疗前IAP(mm Hg)分别为:7.35±2.70、7.42±2.75(P>0.05),液体治疗治疗后72小时IAP(mm Hg)分别为:15.05士3.70、20.32士3.32(P<0.01),研究表明两组液体治疗前IAP差异无统计学意义,但对照组在液体治疗后72小时后IAP显著大于实验组,差异有统计学意义;3分别比较实验组与对照组入院时血浆TNF-α与IL-1的浓度,差异均无统计学意义,而治疗72 h后的两种细胞因子浓度,实验组与对照组相比,均有显著下降,差异有统计学意义;4 Pearson相关分析显示:实验组与对照组液体治疗正平衡量(总输入量与总出量差值)与腹内压呈显著正相关。结论采用HVHF对急性重症胰腺炎早期进行干预能减少液体正平衡,减轻液体治疗后腹内压的升高幅度,可能减少腹腔高压综合征发生的机率。

Objective To analyze the result of fluid balance on intra-abdominal pressure in patients with sever acute pancreatitis undergoing the implementation of HVHF in the early stage treatment. Methods A retrospective control study was performed, Various clinical parameters were analyzed in 66 patients with sever acute pancreatitis was conducted in an intensive care unit at our hospital from August 2013 to December 2015 ,which were randomly divided into 33 examples as experimental group treated by HVHF and the other 33 examples as control group. The goal of fluid management was administrated by early goal-directed therapy（EGDT）. The general information, volume of fluid balance and IAP were analyzed in the two groups. Results ① The fluid balance were both positive in two groups in 72 h after admission, the volume of the total fluid loading administration were higher in the control group than in the experi- mental group（6 230 ± 1 250 ml,10 806 2 100 ml, P 〈0. 01 ）. ②There was no significant difference in IAP between the experi- mental group and the control group after admission （ 7.35 ± 2.70,7.42 ± 2. 75 ） （ P 〈 0. 01 ）, but it significantly reduced in the experimental group compared with the control group in 72 h after admission（ 15.05 ± 3.70,20. 32 ±3.32） （P 〈0. 01 ）. ③ There was no significant difference about the levels of IL-1 and TNF-α in the peripheral plasmain between the two groups after admission, but they significantly reduced in the experimental group compared with the control group in 72 h after admission. ④ The Pearson correlation a- nalysis showed that the volome of fluid balance was correlated positively with the lAP in the experimental group （r = 0. 62 ,P 〈 0. 01 ） and control group （ r = 0. 65, P 〈 0. 01 ）. Conclusion For patients with sever acute pancreatitis, the implementation of high volume hemofiltration pancreatitis in the early stage treatment ,was associated with reduced positive fluid balance and decreased elevation for in- tra-abdominal pressure,and may reduce the occurrence rate of abdominal compartment syndrome.