液体复苏对重症急性胰腺炎患者全身炎症反应的影响研究

Study on the effect of fluid resuscitation on systemic inflammatory response in patients with severe acute pancreatitis

目的探讨早期液体复苏对重症急性胰腺炎(SAP)患者全身炎症反应的影响。方法对该院重症医学科2016年5月至2019年5月收治的44例SAP患者,进行限制性容量复苏,连续血液净化,生长抑素、加贝酯抑制胰腺分泌,抑酸,预防感染、控制血糖、纠正内环境紊乱,中药灌肠等标准治疗,观察患者治疗72 h内液体平衡的总量、72 h后的乳酸水平、腹腔压力、氧合指数、白细胞介素6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,症状缓解情况。结果72 h内液体平衡情况与治疗后的氧合指数呈负相关(P<0.05),与腹腔压力、IL-6和TNF-α水平呈正相关(P<0.05),72 h内液体平衡情况是早期症状能否缓解的相关因素(P<0.05)。结论在治疗SAP患者早期,采用液体复苏以减少液体正平衡能降低患者的全身炎症反应。

Objective To explore the effect of early fluid resuscitation on systemic inflammatory response in patients with severe acute pancreatitis(SAP).Methods The 44 SAP patients admitted to the ICU of the hospital from May 2016 to May 2019 were subjected to restrictive volume resuscitation,continuous blood purification,somatostatin and gabexate inhibit pancreatic secretion,inhibit acid,prevent infection,and control Standard treatments such as blood sugar,correction of internal environment disorders,and traditional Chinese medicine enema.Observing the patient′s total fluid balance within 72 hours of treatment,lactic acid level,abdominal pressure,oxygenation index,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels,and symptom relief after 72 hours.Results Fluid balance within 72 hours was negatively correlated with oxygenation index after treatment(P<0.05),and positively correlated with abdominal pressure,IL-6 and TNF-αlevels(P<0.05),fluid balance within 72 hours was an early symptom Relevant factors can be alleviated(P<0.05).Conclusion In the early treatment of SAP patients,the use of fluid resuscitation to reduce the positive fluid balance can reduce the patient′s systemic inflammatory response.