重症急性胰腺炎的液体复苏

Fluid resuscitation of severe acute pancreatitis

重症急性胰腺炎是一种病情危重,病程长的消化道疾病。其病理生理变化主要是早期炎症介质释放,全身的毛细血管通透性增加导致大量体液渗入腹腔或腹膜后间隙,可致多器官出现液体不平衡,有效血容量减少,甚至出现低血容量性休克。因此,早期液体复苏是治疗和改善急性胰腺炎的关键手段,重症急性胰腺炎根据病情、类型和程度的不同,相应补液方案也不同,需要按照个性化的治疗原则。但目前补液方案均为专家推荐,没有提出明确的补液剂量、补液率、补液药物和补液目标。本文就重症急性胰腺炎液体失衡评估的进展、早期液体复苏的治疗进行综述和总结。

Severe acute pancreatitis is a serious and long-term gastrointestinal disease.Its pathophysiological changes are mainly the release of early inflammatory mediators,and increased capillary permeability throughout the body results in a large amount of fluid infiltration into the abdominal cavity or retroperitoneal space,It may lead to fluid imbalance in multiple organs,reduced effective blood volume,and even hypovolemic shock.Therefore,early fluid resuscitation is the key method to treat and improve acute pancreatitis.Severe acute pancreatitis varies according to the condition,type and extent,the corresponding rehydration regimen is also different and the treatment principles need to be based on individualized.However,the current rehydration schemes are all recommended by experts,no clear rehydration dose,rehydration rate,rehydration medication and rehydration target.In this paper,the progress of evaluation of fluid imbalance in severe acute pancreatitis,treatment of early fluid resuscitation and experience were discussed.