大容量液体复苏降低重症急性胰腺炎死亡风险

Association between large volume fluid resuscitation and mortality in severe acute pancreatitis

目的探讨重症急性胰腺炎患者早期大容量液体复苏与住院死亡风险的关系。方法收集2014年1月1日至2018年10月31日期间重症急性胰腺炎住院患者资料,包括性别,年龄、身高、体重、入院时生命体征,入院24小时液体复苏量、治疗结局等相关指标;根据液体复苏量的不同进行分组,寻找多器官功能衰竭及死亡风险的影响因素。结果研究共包含231例,入院24小时液体容量≥6 000 ml有76例,平均补液量为(7 628±3 018) ml;<6 000 ml有155例,平均补液量为(4 642±2 018) ml,两组住院死亡率分别为10.53%和21.94%(P<0.05)。大容量补液组多器官功能衰竭比例减少(呼吸衰竭、肾功能衰竭)(P<0.035);有创机械通气比例、血液净化比例减少(P<0.05)。结论入院24小时内大容量液体复苏能降低重症急性胰腺炎患者死亡风险,多器官功能衰竭比例,因此重症急性胰腺炎患者应予于早期足量补液。

Objective To explore the association between the large volume fluid resuscitation and hospital mortality risk in severe acute pancreatitis.Methods Data were collected from hospitalized patients with severe acute pancreatitis from January 1,2014 to October 31,2018,including gender,age,height,weight,vital signs at admission,24-hour fluid resuscitation,and treatment outcomes.According to the different amounts of fluid resuscitation,patients were grouped to find the factors influencing the risk of multiple organ failure and death.Results A total of 231 patients were included in the study,76 of whom were admitted to the hospital with a 24-hour liquid volume of≥6 000 ml,with an average fluid rehydration volume of(7 628±3 018)ml.There were 155 patients with<6 000 ml,and the average fluid intake was(4 642±2 018)ml.The mortality rates in the two groups were 10.53%and 21.94%,respectively(P<0.05).The proportion of multiple organ failure(respiratory failure,renal failure)was reduced in the high-volume fluid infusion group(P<0.035).The proportion of invasive mechanical ventilation and blood purification was decreased(P<0.05).Conclusion Large volume fluid resuscitationis associated with decreased mortality and multiple organ failure.Sufficient fluid should be supplied in the early stage in severe pancreatitis.