重症急性胰腺炎的早期液体复苏和器官保护

Early fluid resuscitation and organ protection in severe acute pancreatitis

液体复苏和器官功能保护是重症急性胰腺炎(SAP)早期治疗的2个关键环节。一旦诊断为SAP应立即开始液体复苏,尤其合并休克或脱水的病人。平衡液是复苏首选液体,常用乳酸林格液;接受大量晶体液时可使用白蛋白。液体复苏的起始液体速率和剂量需结合复苏目标和监测来定,进行滴定式液体复苏,需遵循个体化、精准化、限制性原则,充分复苏的同时避免液体过负荷。SAP早期器官功能障碍强调早期发现、干预并保护性治疗,以防止多器官功能障碍的发生和进展。预防重于治疗,早期以ICU为主导的监测、适当的液体复苏、器官功能支持和内科综合治疗更为重要。具体措施包括及时的病因治疗、早期液体复苏和循环支持、调节炎性反应、改善肠道屏障功能、血液净化治疗、呼吸早期支持、肾脏支持、抗凝、脑保护、感染控制、镇痛镇静等。

Fluid resuscitation and organ function protection are two key steps in the early treatment of severe acute pancreatitis(SAP).Fluid resuscitation should be evaluated immediately upon diagnosis of SAP,especially in patients with shock or dehydration.Equilibrium fluid is the preferred recommended fluid for resuscitation,and lactate Ringer's fluid is commonly used.Albumin may be used when receiving large amounts of crystalloid.The initial liquid rate and dosage of fluid resuscitation should be determined in combination with the resuscitation target and monitoring,and titrated liquid resuscitation should be carried out by the principles of individualization,precision,and restriction to avoid overload.Early organ dysfunction affects the prognosis of SAP,and early prophylaxis,detection,intervention,and protection are emphasized to prevent the occurrence and progression of multiple organ dysfunction.Prevention is more important than treatment.Early monitoring in the ICU,standardized fluid resuscitation,organ function support and comprehensive medical treatment are more important.Management measures include etiological treatment,early fluid resuscitation and circulation support,regulation of inflammatory response,improvement of intestinal barrier function,blood purification therapy,early respiratory support,kidney support,anticoagulation,brain protection,infection control,analgesia and sedation.