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目的探讨重症胰腺炎急性反应期液体治疗策略。方法 2001年3月至2006年1月将符合研究标准的83例重症急性胰腺炎(severe acute panereatitis,SAP)患者纳入研究。根据入院后扩容达标时间分为早期扩容达标组(Ⅰ组,21例)、中期扩容达标组(Ⅱ组,35例)和晚期扩容达标组(Ⅲ组,27例)。观察入院日至入院后72h 内的液体治疗参数、血清乳酸水平、急性和慢性健康状况评分(APACHEⅡ评分)、机械通气率、腹腔间隔室综合征发生率及治愈率等指标。结果Ⅰ组、Ⅱ组、Ⅲ组的扩容达标时间分别为(13±6)h,(38±5)h和(61±8)h,且3组间差异均有统计学意义(P<0.05);3组达标时的血清乳酸水平较入院水平差异有统计学意义(P<0.05),且恢复至正常水平。红细胞压积(HCT):入院后第1天Ⅰ组(33±6)%,显著低于Ⅱ组(40±6)%和Ⅲ组(42±11)%(P<0.01),Ⅱ组和Ⅲ组间差异无统计学意义。入院日,Ⅰ组输注晶体(4014±2887)ml、胶体量(1220±705)ml,显著高于Ⅱ组(2366±1959)ml 和(821±600)ml 以及Ⅲ组(2615±1574)ml 和(701±585)ml(P<0.01),Ⅱ组和Ⅲ组间差异无统计学意义(P>0.05)。入院日,Ⅲ组胶、晶体比值显著低于Ⅰ组和Ⅱ组(P<0.05)。4d 的液体输注总量3组间差异无统计学意义(P>0.05)。输液速率入院日Ⅰ组显著高于Ⅱ组和Ⅲ组(P<0.05)。4d 液体潴留量Ⅱ组显著低于Ⅰ组和Ⅲ组(P<0.05)。入院后1～3 d Ⅰ组的 APACHE Ⅱ评分显著高于Ⅱ组和Ⅲ组(P<0.05)。Ⅰ组的机械通气率(85.7%)显著高于Ⅱ组(37.1%)和Ⅲ组(63.0%)(P<0.05);Ⅱ组腹腔间隔室综合征发生率(37.1%)最低(P<0.05);Ⅰ组存活率(38.1%)显著低于Ⅱ组(85.7%)和Ⅲ组(66.7%)(P<0.05)。结论 SAP 发病72h 内控制性血容量扩充和防止体液潴留可显著提高其治愈率。
Objective To investigate the acute treatment of severe pancreatitis liquid response strategy. Methods From March 2001 to January 2006, 83 patients with severe acute panereatitis (SAP) meeting the research criteria were included in the study. According to the time of admission and expansion, the patients were divided into two groups: group Ⅰ (n = 21), group Ⅱ (n = 35) and group Ⅱ (n = 27). The parameters of fluid treatment, serum lactate level, acute and chronic health score (APACHEⅡscore), mechanical ventilation rate, incidence of celiac compartment syndrome and cure rate were observed from 72 days after admission to admission. Results The time to reach the goal of expansion in group Ⅰ, group Ⅱ and group Ⅲ was (13 ± 6) h, (38 ± 5) h and (61 ± 8) h, respectively, and the differences among the three groups were statistically significant (P <0.05 ). The serum lactic acid levels of the three groups reached statistical significance (P <0.05) when compared with the admission level and returned to normal levels. Hematocrit (HCT) was significantly lower in group Ⅰ (33 ± 6)% on day 1 after admission than in group Ⅱ (40 ± 6)% and group Ⅲ (42 ± 11)% (P0.01) No significant difference between the three groups. On admission day, the volume of colloid (1220 ± 705) ml in group Ⅰ was significantly higher than that in group Ⅱ (2366 ± 1959) ml and (821 ± 600) ml and group Ⅲ (2615 ± 1574) ml and (701 ± 585) ml respectively (P <0.01). There was no significant difference between group Ⅱ and group Ⅲ (P> 0.05). On the day of admission, the group Ⅲ gel and crystal ratio were significantly lower than those in group Ⅰ and group Ⅱ (P <0.05). There was no significant difference in the total volume of liquid infusion between the 4 groups (P> 0.05). The infusion rate in admission Ⅰ group was significantly higher than that in Ⅱ and Ⅲ group (P <0.05). The amount of fluid retention in group Ⅱ was significantly lower than that in groups Ⅰ and Ⅲ (P <0.05). The APACHE Ⅱ score of Ⅰ ~ 3 d group Ⅰ was significantly higher than that of Ⅱ and Ⅲ group after admission (P <0.05). The mechanical ventilation rate in Group Ⅰ was significantly higher than that in Group Ⅱ (37.1% vs 63.0%, P <0.05). The incidence of ICS in Group Ⅱ was the lowest (37.1%) (P <0.05) ). The survival rate of group Ⅰ (38.1%) was significantly lower than that of group Ⅱ (85.7%) and group Ⅲ (66.7%) (P <0.05). Conclusion Controlled volume expansion and prevention of fluid retention during 72 hours after SAP onset can significantly improve the cure rate.