摘要
目的探讨不同晶胶比液体早期复苏对重症急性胰腺炎（SAP）患者预后的影响。方法回顾性分析本院2001年1月至2011年12月47例SAP患者的临床资料。以第一个24h液体晶胶比1．5和3为界，将患者分成低晶胶比组（晶胶比〈1．5，13例）、中晶胶比组（晶胶比1．5—3，15例）和高晶胶比组（晶胶比〉3，19例），观察入院后液体复苏成功患者的第一个24h机械通气率、氧合指数、腹腔内压（1AP）、第三间隙液体潴留量、液体复苏量参数及患者2周内存活率。结果①入院后第一个24h，高晶胶比组机械通气率显著高于中、低品胶比组（68．4％比20．0％、23．1％，均P〈0．05），氧合指数（mmHg，1mmHg=0．133kPa）明显低于中、低品胶比组（180．7±26.3比280．6±24．8、260.3±25．7，均P〈0．05），IAP（cmH2O，1cmH2O=0．098kPa）明显高于中、低晶胶比组（16．8±3．6比13．4±3．5、13．1±3.3，均P〈0．05），液体潴留量（ml）显著高于中、低晶胶比组（2834±631比1887±282、1865±300，均P〈0．05），而中晶胶比组与低晶胶比组比较差异均无统计学意义（均P〉0．05）。②入院后第一个24h，高晶胶比组输注晶体液量（ml）明显高于中、低晶胶比组（3611±798比2308±416、2124±477，均P〈0．05）；高、中晶胶比组胶体液量（ml）明显低于低晶胶比组（993±233、948±140比1506±332，均P〈0．05）：晶胶比值高晶胶比组（3．65±0．13）〉中晶胶比组（2．43±0．13）〉低晶胶比组（1．41±0．08，均P〈0．05）。复苏后72h，高晶胶比组总液体量（m1）明显高于中、低晶胶比组（11941±1161比9036±982、9400±1051，均P〈0．05）。③高晶胶比组2周内存活率（36．8％）显著低于中晶胶比组（86．7％，P〈0．05）和低品胶比组（61．5％，P〉0．05）。结论对SAP患者早期宜采用适当晶胶比的控制性液体复苏，可减轻体液潴留和提高治愈率，且采用中晶胶比的控制性液体复苏策略效果最佳。
Objective To investigate the impact of fluid resuscitation with different ratio of crystalloid-colloid in early resuscitation stage on prognosis of patients with severe acute pancreatitis （SAP）. Methods A retrospective analysis was made by reviewing clinical data of 47 patients with SAP from January 2001 to December 2011. According to crystalloid-colloid ratio 1.5 or 3, which was the input volume of crystalloid fluid versus colloid fluid in the first 24 hours, patients were divided into low ratio group （crystalloid-colloid ratio〈1.5, n =13）, middle ratio group （crystalloid-colloid ratio 1.5-3, n = 15 ） and high ratio group （crystalloid-colloid ratio 〉3, n = 19）. Among the patients who had been successfully resuscitated, rate of mechanical ventilation, the oxygenation index, intra-abdominal pressure （IAP）, and the amount of fluid retention in the third space within the first 24 hours, as well as the parameters of fluid resuscitation and the survival rate within 2 weeks were collected and analyzed. Results .①In the first 24 hours, the rate of mechanical ventilation in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group （68.4% vs. 20.0%, 23.1%, both P〈0.05）; the oxygenation index （mm Hg, 1 mm Hg= 0.133 kPa） was significantly lower than that in the middle ratio group and in the low ratio group （180.7 226.3 vs. 280.6 2 24.8, 260.3 ± 25.7, both P〈0.05）; the IAP （cm H2O, 1 cm H2O =0.098 kPa） was significantly higher than that in the middle ratio group and the low ratio group （ 16.8 ± 3.6 vs. 13.4 ± 3.5, 13.1 ± 3.3, both P〈0.05） ; the amount of fluid retention （ml） in the third space was significant higher than that in the middle ratio group and the low ratio group （2834 2 631 vs. 1887 2 282, 1865 ± 300, both P〈0.05）. There was no significant difference in above indexes between middle ratio group and low ratio group （all P〉0.05）. ② In the first 24 hours, the volume of crystaUoid （ml） in high ratio group was significantly larger than that in the middle ratio group and the low ratio group （3611 2 798 vs. 2308 ± 416, 2124 ±477, both P〈0.05）; and the volume of colloid （ml） in high ratio group and middle ratio group was significantly lower than that in the low ratio group （993 ± 233,948 ± 140 vs. 1506 2 332, both P〈0.05 ） ; and the mean crystalloid-colloid rate in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group （3.65±0.13 vs. 2.43±0.13, 1.4120.08, both P〈0.05）. Thevolume （ ml ） of infused fluid during the first 72 hours in the high ratio group was significantly higher than that in the middle and low ratio groups （ 11 941 ± 1161 vs.9036 ± 982, 9400 ±1051, both P〈0.05 ）.③ The survival rate in the high ratio group （36.8%） was significantly lower than that in the middle ratio group （86.7%, P〈0.05 ） and the low ratio group （61.5%, P〉0.05 ）. Conclusions A suitable crystalloid-colloid ratio should be considered in the early stage of resuscitation in patients with severe acute panereatitis, which would result in a decrease in the fluid retention in the third space as well as an improvement of survival rate in return. It is suggested that the middle ratio of crystalloid-eolloid fluid resuscitation should be the optimal strategy.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第1期48-51,共4页
Chinese Critical Care Medicine
基金
江西省医药卫生科技计划支撑项目（20111018）
关键词
胰腺炎
急性
重症
液体复苏
晶胶比
存活率
Severe acute panereatitis
Fluid resuscitation
Crystalloid-colloid ratio
Survival rate
