早期液体复苏对重症急性胰腺炎预后的影响

The effects of early fluid resuscitation on the prognosis of patients with severe acute pancreatitis

目的探讨早期液体复苏对重症急性胰腺炎患者预后的影响。方法采用回顾性分析法,选取2014年10月至2018年7月收治的重症急性胰腺炎患者100例的临床资料进行研究。按照治疗方法的不同将患者分为对照组和观察组,每组50例。对照组患者采用常规综合治疗,观察组在对照组治疗的基础上联合早期液体复苏治疗。观察2组患者临床疗效、指标变化和预后情况。结果观察组患者TBIL、Cr、BUN、ALT、AMY、AST明显低于对照组,差异均有统计学意义(P<0.05);观察组患者PaO 2明显高于对照组,差异均有统计学意义(P<0.05);观察组患者扩容达标时输液速度明显低于对照组,差异均有统计学意义(P<0.05);观察组患者扩容达标时红细胞压积、液体潴留总量明显高于对照组,差异均有统计学意义(P<0.05);观察组患者腹腔压力>20 cm H 2O、新发器官衰竭、机械通气、床旁血滤例数均明显低于对照组,差异均有统计学意义(P<0.05);观察组患者入住ICU时间明显短于对照组,差异均有统计学意义(P<0.05);观察组患者中转手术低于对照组,但2组比较差异无统计学意义(P>0.05);观察组患者EN开始时间短于对照组,但2组比较差异无统计学意义(P>0.05);观察组患者总有效率90.0%,对照组患者总有效率70.0%,2组患者临床疗效比较,差异有统计学意义(P<0.05);观察组患者Ranson评分、APACHEⅡ评分、CTSI评分明显低于对照组,差异均有统计学意义(P<0.05);观察组患者多脏器功能衰竭、急性呼吸窘迫综合症、急性肾损伤等并发症明显低于对照组(P<0.05)。结论重症急性胰腺炎利用早期液体复苏治疗具有很好的效果,可早期实现患者液体相对平衡,改善患者的微循环,减少并发症,改善患者预后,值得临床推广和应用。

Objective To investigate the effects of early fluid resuscitation on the prognosis of patients with severe acute pancreatitis.Methods The clinical data about 100 patients with severe acute pancreatitis who were admitted and treated in our hospital from October 2014 to July 2018 were retrospectively analyzed.These patients were divided into control group and observation group according to different treatment methods,with 50 cases in each group.The patients in control group were treated by conventional comprehensive therapy,however,the patients in observation group,on the basis of control group,were treated by early liquid resuscitation therapy.The clinical curative effects,index changes and prognosis of patients were observed and compared between the two groups.Results The levels of TBIL,Cr,BUN,ALT,AMY and AST in observation group were significantly lower than those in control group(P<0.05),however,the PaO 2 levels in observation group were significantly higher than those in control group(P<0.05).The infusion velocity in observation group was significantly lower than that in control group(P<0.05),but the red blood cell volume and fluid retention volume when the expansion reached the standard in observation group were significantly higher than those in control group(P<0.05).The cases with peritoneal pressure>20 cm H 2O,new organ failure,mechanical ventilation,and bedside blood filtration in observation group were significantly less than those in control group(P<0.05).The time of staying in ICU in observation group was significantly shorter than that in control group.The start time of EN in observation group was shorter than that in control group,but there was no significant difference between the two groups(P>0.05).The total effective rate in observation group was 90.0%,which was significantly higher than that(70.0%)in control group(P<0.05).Moreover the Ranson scores,APACHEⅡscores and CTSI scores in observation group were significantly lower than those in control group(P<0.05),and the incidence rates of complications including multiple organ failure,acute respiratory distress syndrome and acute kidney injury in observation group were significantly lower than those in control group(P<0.05).Conclusion The early fluid resuscitation has better effects on severe acute pancreatitis,which can promote the relative balance of fluid,improve the patient's microcirculation,reduce complications,improve the prognosis of patients,therefor,which is worthy of clinical promotion and application.