搜索

重癥急性胰腺炎早期液體復(fù)蘇的臨床研究

摘要:目的：探討急性重癥胰腺炎（SAP）早期不同種類液體復(fù)蘇對其預(yù)后的影響。方法：應(yīng)用隨機(jī)對照的方法,分別對2007年12月~2009年10月同期入院的48例SAP患者,隨機(jī)分成兩組,試驗(yàn)組和對照組。試驗(yàn)組第一周內(nèi)液體復(fù)蘇采用晶體液和人工膠體（羥乙基淀粉）,對照組采用晶體液,其他治療方法不變。然后統(tǒng)計(jì)其第一周死亡率、ARDS、多器官功能障礙綜合征（MODS）發(fā)生率,對比兩組患者呼吸頻率、血氧飽和度和紅細(xì)胞壓積（HCT）差異,以及兩組患者腸功能恢復(fù)時(shí)間、住院時(shí)間以及并發(fā)癥發(fā)生率。結(jié)果：試驗(yàn)組的液體復(fù)蘇較對照組顯著改善SAP的各項(xiàng)指標(biāo)（P＜005）。血清乳酸水平（15±05）mmol/L,紅細(xì)胞壓積(HCT)為（324±69）%,ScvO2為（817±152）%,病死率83%,MODS發(fā)生率333%,〖HT5”H〗結(jié)論:〖HT5”SS〗 SAP早期聯(lián)合應(yīng)用晶膠體進(jìn)行液體復(fù)蘇可有效恢復(fù)循環(huán)血容量和防止體液潴留,顯著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.