CAJ | 학술논문

目的：探讨容量复苏达标后液体正负平衡对急性重症胰腺炎（SAP）的影响。方法选择经持续肾替代治疗（CR-RT）的SAP患者42例，根据复苏达标后48h液体出入量分为正平衡组及负平衡组，记录并比较复苏达标后0、24、48h血流动力学指标、血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）、氧合指数（PO2/FiO2）、膀胱内压（IAP）、血浆脑钠肽（BNP）、血乳酸及每24h液体出入量、ICU住院时间、机械通气时间、CRRT时间。结果负平衡组较正平衡组ICU住院时间、机械通气时间短（均P＜0.05）。CRRT时间两组间差异无统计学意义（P＞0.05）。容量复苏后24、48h负平衡组EVLWI、IAP、血乳酸均低于正平衡组（均P＜0.05）， PO2/FiO2高于正平衡组（均P＜0.05），BNP在48h低于正平衡组（P＜0.05）。结论 SAP患者容量复苏达标后宜采用适度液体负平衡策略。
목적：탐토용량복소체표후액체정부평형대급성중증이선염（SAP）적영향。방법선택경지속신체대치료（CR-RT）적SAP환자42례，근거복소체표후48h액체출입량분위정평형조급부평형조，기록병비교복소체표후0、24、48h혈류동역학지표、혈관외폐수지수（EVLWI）、폐혈관통투성지수（PVPI）、양합지수（PO2/FiO2）、방광내압（IAP）、혈장뇌납태（BNP）、혈유산급매24h액체출입량、ICU주원시간、궤계통기시간、CRRT시간。결과부평형조교정평형조ICU주원시간、궤계통기시간단（균P＜0.05）。CRRT시간량조간차이무통계학의의（P＞0.05）。용량복소후24、48h부평형조EVLWI、IAP、혈유산균저우정평형조（균P＜0.05）， PO2/FiO2고우정평형조（균P＜0.05），BNP재48h저우정평형조（P＜0.05）。결론 SAP환자용량복소체표후의채용괄도액체부평형책략。
Objective To investigate the effects of different fluid management for severe acute pancreatitis(SAP)after flu-id resuscitation. Methods Forty two patients with SAP treated by continuous renal replacement therapy(CRRT)were classified as positive(n=18) and negative groups(n=24), according to liquid intake and output after 48h of resuscitation. The hemodynamic in-dexes, extravascular lung water index (EVLWI), pulmonary vascular permeability index, oxygenation index (PO2/FiO2), bladder pressure(ICP), B- type natriuretic peptide(BNP), blood lactic acid, liquid intake and output every 24h, the length of ICU stay, me-chanical ventilation and CRRT were documented and compared between two groups. Results The length of ICU stay and me-chanical ventilation in negative group was shorter than those in positive group(P<0.05). There was no significant difference in the length of CRRT between two groups(P>0.05). At 24, 48h after resuscitation, EVLWI, ICP, blood lactic acid in negative group were lower and PO2/FiO2 was higher than those in positive group(P<0.05);BNP in negative group was lower than that in positive group at 48h (P<0.05). Conclusion Liquid negative balance would be beneficial for patients with severe acute pancreatitis after fluid resuscitation.