中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
8期
458-461
,共4页
冯永文%吴明%曾晶晶%李颖%李明利%崔曼丽
馮永文%吳明%曾晶晶%李穎%李明利%崔曼麗
풍영문%오명%증정정%리영%리명리%최만려
胰腺炎,急性,重症%液体复苏%晶胶比%血管外肺水指数%膀胱内压%B型钠尿肽
胰腺炎,急性,重癥%液體複囌%晶膠比%血管外肺水指數%膀胱內壓%B型鈉尿肽
이선염,급성,중증%액체복소%정효비%혈관외폐수지수%방광내압%B형납뇨태
Severe acute pancreatitis%Fluid resuscitation%Crystalloid-colloid ratio%Extravascular lung water index%Bladder pressure%B-type natriuretic peptide
目的 探讨不同晶胶比液体复苏对重症急性胰腺炎(SAP)患者血管外肺水(EVLW)的影响.方法 回顾性分析本院2009年1月至2010年12月重症医学科24例SAP患者的临床资料.所有患者的胸内血容量指数(ITBVI)均＜750 ml/m2,以ITBVI 850～1 000 ml/m2作为复苏终点.以晶胶比3:1为界,将患者分成低晶胶比组(13例)和高晶胶比组(11例),观察液体复苏前及复苏后即刻(0)、24、48、72 h患者血流动力学、血管外肺水指数(EVLWI)、氧合指数(PaO2/FiO2)、膀胱内压(ICP)、B型钠尿肽(BNP)的变化;采用脉搏指示连续心排血量(PiCCO)热稀释法测定EVLWI,用放射免疫法测定BNP.结果 ①早期采用不同晶胶比液体复苏均可改善SAP患者血流动力学指标.②复苏后72 h高晶胶比组总液体量[(16 438±1 758)ml]、晶体液量[(13 459±425)m1]及晶/胶比值(4.50±0.23)均明显高于低晶胶比组[分别为(13 895±1 783)ml、(6 945±454)ml、2.32±0.18,P＜0.05或P＜0.01].③与低晶胶比组比较,高晶胶比组复苏后48 h和72 hPaO2/FiO2(mm Hg,1 mm Hg=0.133 kPa)明显下降(48 h:186.51±42.26比268.35±34.18,72 h:172.85±21.50比263.95±24.20),EVLWI、ICP及BNP均明显升高[EVLWI(ml/kg)48 h:14.52±1.08比10.40±1.16,72 h:14.92±0.86比10.52±1.02;ICP(cm H2O,1 cm H2O=0.098 kPa)48 h:16.23±1.32比13.05±1.70,72 h:17.39±1.56比13.42±1.65;BNP(ng/L)48 h:424.29±74.25比225.32±53.58,72 h:620.49+79.53比288.28±68.78,P＜0.05或P＜0.01].④Pearson相关分析显示:EVLWI与PaO2/FiO2呈显著负相关(r=-0.71,P＜0.01),与ICP、BNP呈显著正相关(r1=0.63,r2=0.56,均P＜0.01).结论 对SAP患者早期应监测EVLWI、ICP及BNP以指导液体复苏,且宜采用提高胶体比例的限制性液体复苏策略.
目的 探討不同晶膠比液體複囌對重癥急性胰腺炎(SAP)患者血管外肺水(EVLW)的影響.方法 迴顧性分析本院2009年1月至2010年12月重癥醫學科24例SAP患者的臨床資料.所有患者的胸內血容量指數(ITBVI)均＜750 ml/m2,以ITBVI 850～1 000 ml/m2作為複囌終點.以晶膠比3:1為界,將患者分成低晶膠比組(13例)和高晶膠比組(11例),觀察液體複囌前及複囌後即刻(0)、24、48、72 h患者血流動力學、血管外肺水指數(EVLWI)、氧閤指數(PaO2/FiO2)、膀胱內壓(ICP)、B型鈉尿肽(BNP)的變化;採用脈搏指示連續心排血量(PiCCO)熱稀釋法測定EVLWI,用放射免疫法測定BNP.結果 ①早期採用不同晶膠比液體複囌均可改善SAP患者血流動力學指標.②複囌後72 h高晶膠比組總液體量[(16 438±1 758)ml]、晶體液量[(13 459±425)m1]及晶/膠比值(4.50±0.23)均明顯高于低晶膠比組[分彆為(13 895±1 783)ml、(6 945±454)ml、2.32±0.18,P＜0.05或P＜0.01].③與低晶膠比組比較,高晶膠比組複囌後48 h和72 hPaO2/FiO2(mm Hg,1 mm Hg=0.133 kPa)明顯下降(48 h:186.51±42.26比268.35±34.18,72 h:172.85±21.50比263.95±24.20),EVLWI、ICP及BNP均明顯升高[EVLWI(ml/kg)48 h:14.52±1.08比10.40±1.16,72 h:14.92±0.86比10.52±1.02;ICP(cm H2O,1 cm H2O=0.098 kPa)48 h:16.23±1.32比13.05±1.70,72 h:17.39±1.56比13.42±1.65;BNP(ng/L)48 h:424.29±74.25比225.32±53.58,72 h:620.49+79.53比288.28±68.78,P＜0.05或P＜0.01].④Pearson相關分析顯示:EVLWI與PaO2/FiO2呈顯著負相關(r=-0.71,P＜0.01),與ICP、BNP呈顯著正相關(r1=0.63,r2=0.56,均P＜0.01).結論 對SAP患者早期應鑑測EVLWI、ICP及BNP以指導液體複囌,且宜採用提高膠體比例的限製性液體複囌策略.
목적 탐토불동정효비액체복소대중증급성이선염(SAP)환자혈관외폐수(EVLW)적영향.방법 회고성분석본원2009년1월지2010년12월중증의학과24례SAP환자적림상자료.소유환자적흉내혈용량지수(ITBVI)균＜750 ml/m2,이ITBVI 850～1 000 ml/m2작위복소종점.이정효비3:1위계,장환자분성저정효비조(13례)화고정효비조(11례),관찰액체복소전급복소후즉각(0)、24、48、72 h환자혈류동역학、혈관외폐수지수(EVLWI)、양합지수(PaO2/FiO2)、방광내압(ICP)、B형납뇨태(BNP)적변화;채용맥박지시련속심배혈량(PiCCO)열희석법측정EVLWI,용방사면역법측정BNP.결과 ①조기채용불동정효비액체복소균가개선SAP환자혈류동역학지표.②복소후72 h고정효비조총액체량[(16 438±1 758)ml]、정체액량[(13 459±425)m1]급정/효비치(4.50±0.23)균명현고우저정효비조[분별위(13 895±1 783)ml、(6 945±454)ml、2.32±0.18,P＜0.05혹P＜0.01].③여저정효비조비교,고정효비조복소후48 h화72 hPaO2/FiO2(mm Hg,1 mm Hg=0.133 kPa)명현하강(48 h:186.51±42.26비268.35±34.18,72 h:172.85±21.50비263.95±24.20),EVLWI、ICP급BNP균명현승고[EVLWI(ml/kg)48 h:14.52±1.08비10.40±1.16,72 h:14.92±0.86비10.52±1.02;ICP(cm H2O,1 cm H2O=0.098 kPa)48 h:16.23±1.32비13.05±1.70,72 h:17.39±1.56비13.42±1.65;BNP(ng/L)48 h:424.29±74.25비225.32±53.58,72 h:620.49+79.53비288.28±68.78,P＜0.05혹P＜0.01].④Pearson상관분석현시:EVLWI여PaO2/FiO2정현저부상관(r=-0.71,P＜0.01),여ICP、BNP정현저정상관(r1=0.63,r2=0.56,균P＜0.01).결론 대SAP환자조기응감측EVLWI、ICP급BNP이지도액체복소,차의채용제고효체비례적한제성액체복소책략.
Objective To investigate the effects of fluid resuscitation with different crystalloid-colloid ratio on extravascular lung water (EVLW) in patients with severe acute pancreatitis (SAP). Methods Clinical data of 24 SAP patients ,who had undergone intrathoracic blood volume index (ITBVI ＜750 ml/m2),were analyzed retrospectively, in Department of Critical Care Medicine in the First Affiliated Hospital of Shenzhen University, during January of 2009 to December of 2010. ITBVI 850 - 1 000 ml/m2 was confirmed the end criterion of the end point of resuscitation. Low crystalloid-colloid ratio group (n = 13) and high crystalloid-colloid ratio group (n = 11) were divided according to crystalloid-colloid ratio (3∶1) as the borderline. Hemodynamic parameters, extravascular lung water index (EVLWI), oxygenation index (PaO2/FiO2), bladder pressure (ICP) and B-type natriuretic peptide (BNP) were observed at the time point of before fluid resuscitation, and 0, 24 ,48, 72 hours after resuscitation, EVLWI was measured with thermal dilution pulse index continuous cardiac output (PiCCO), and BNP with radioimmunoasaay. Results ① Hemodynamic parameters can be improved at early fluid resuscitation stage in both groups. ② The total amount of fluid[(16 438±1 758) ml], amount of crystalloid fluid[(13 459±425) ml]and crystalloid-colloid ratio (4. 50± 0. 23) of the high crystalloid-colloid ratio group was significantly higher than that of the low crystalloid-colloid ratio group[(13 895±1 783) ml, (6 945± 454) ml, 2. 32± 0. 18, respectively, P＜0. 05or P＜0. 01]at the time point of 72 hours after resuscitation. ③ Compared with low crystalloid-colloid ratio group, PaO2/FiO2 (mm Hg, 1 mm Hg=0. 133 kPa) in high crystalloid-colloid ratio group was lowered significantly at 48 hours and 72 hours after resuscitation (48 hours: 186.51 ±42. 26 vs. 268. 35± 34. 18,72 hours: 172.85 ± 21.50 vs. 263. 95 ± 24.20); but EVLWI, ICP and BNP were increased significantly [EVLWI (ml/kg) 48 hours: 14. 52±1.08 vs. 10. 40±1.16, 72 hours: 14. 92±0. 86 vs. 10. 52±1.02); ICP(cmH2O, 1cm H2O=0.098 kPa) 48 hours: 16.23±1.32 vs. 13.05±1.70, 72 hours: 17.39±1.56 vs.13. 42 ±1. 65 ; BNP (ng/L) 48 hours: 424.29±74.25 vs. 225.32±53.58, 72 hours: 620.49±79.53 vs.288. 28±68. 78, P＜0. 05 or P＜0. 01]. ④ The Pearson correlation analysis showed that: EVLWI with PO2/FiO2 was correlated negatively (r = -0. 71, P＜ 0. 01), but with the BNP, ICP showed positive correlation (r1= 0.63, r2 = 0. 56, both P＜0. 01). Conclusion In order to guide early fluid resuscitation,EVLW, ICP and BNP should be monitored and limited fluid resuscitation strategy with an increasing colloid ratio should be adopted for SAP patients.
