中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
8期
576-580
,共5页
急性胰腺炎,重症%液体复苏%氧合指数%预后
急性胰腺炎,重癥%液體複囌%氧閤指數%預後
급성이선염,중증%액체복소%양합지수%예후
Severe acute pancreatitis%Fluid resuscitation%Oxygen index%Prognosis
目的 分析重症急性胰腺炎(SAP)患者早期(起病2周内)液体复苏后液体平衡与氧合指数的相关性,探讨早期液体复苏对预后的影响.方法 采用观察性研究,选择中国医科大学附属盛京医院2011年3月至2013年10月首诊或入普通病房当日即转入重症监护病房(ICU)的成人SAP患者97例,除外终止治疗患者后,最终65例纳入分析.所有患者由同一位ICU医生制定复苏和治疗计划并予以实施.按预后将患者分为好转组和死亡组,比较两组患者入ICU后1、2、3、7、14d液体平衡情况;并采用曲线拟合方法估计每日液体平衡量与氧合指数的相关性.结果 纳入的65例患者中,ICU治疗期间死亡12例,好转转入普通病房53例.好转患者累计液体平衡增长趋势减缓或出现负平衡,而死亡患者仍需液体正平衡;好转组与死亡组各时间段累计液体平衡量(mL)差异均有统计学意义[1 d:1 814.5(905.2,2 152.8)比3 891.0(2 524.2,5 714.5),Z=-3.303,P=0.001;2 d:2 469.0(1 456.0,3 696.0)比6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001;3 d:3 234.0(1 098.0,4 295.5)比9 533.5(6 748.8,10 689.0),Z=-4.684,P＜0.001;7 d:3 234.0(1 033.0,5 162.0)比13 986.5(8045.8,14 518.0),Z=-4.718,P＜0.001; 14 d:3 234.0(978.5,4 924.0)比13 436.5(8 045.8,14 518.0),Z=-4.769,P＜0.001].经治疗好转的患者入ICU 3 d内液体平衡量与氧合指数无明显相关性(R2=0.000,P=0.827);入ICU 3 d后氧合指数与每日液体平衡量之间满足logistic曲线拟合,但拟合度不高(R2=0.036,P＜0.001).结论 早期液体复苏可维持SAP患者血流动力学稳定,能够早期实现液体相对负平衡者预后较佳,且好转患者3d后液体平衡情况与氧合指数符合logistic曲线拟合.
目的 分析重癥急性胰腺炎(SAP)患者早期(起病2週內)液體複囌後液體平衡與氧閤指數的相關性,探討早期液體複囌對預後的影響.方法 採用觀察性研究,選擇中國醫科大學附屬盛京醫院2011年3月至2013年10月首診或入普通病房噹日即轉入重癥鑑護病房(ICU)的成人SAP患者97例,除外終止治療患者後,最終65例納入分析.所有患者由同一位ICU醫生製定複囌和治療計劃併予以實施.按預後將患者分為好轉組和死亡組,比較兩組患者入ICU後1、2、3、7、14d液體平衡情況;併採用麯線擬閤方法估計每日液體平衡量與氧閤指數的相關性.結果 納入的65例患者中,ICU治療期間死亡12例,好轉轉入普通病房53例.好轉患者纍計液體平衡增長趨勢減緩或齣現負平衡,而死亡患者仍需液體正平衡;好轉組與死亡組各時間段纍計液體平衡量(mL)差異均有統計學意義[1 d:1 814.5(905.2,2 152.8)比3 891.0(2 524.2,5 714.5),Z=-3.303,P=0.001;2 d:2 469.0(1 456.0,3 696.0)比6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001;3 d:3 234.0(1 098.0,4 295.5)比9 533.5(6 748.8,10 689.0),Z=-4.684,P＜0.001;7 d:3 234.0(1 033.0,5 162.0)比13 986.5(8045.8,14 518.0),Z=-4.718,P＜0.001; 14 d:3 234.0(978.5,4 924.0)比13 436.5(8 045.8,14 518.0),Z=-4.769,P＜0.001].經治療好轉的患者入ICU 3 d內液體平衡量與氧閤指數無明顯相關性(R2=0.000,P=0.827);入ICU 3 d後氧閤指數與每日液體平衡量之間滿足logistic麯線擬閤,但擬閤度不高(R2=0.036,P＜0.001).結論 早期液體複囌可維持SAP患者血流動力學穩定,能夠早期實現液體相對負平衡者預後較佳,且好轉患者3d後液體平衡情況與氧閤指數符閤logistic麯線擬閤.
목적 분석중증급성이선염(SAP)환자조기(기병2주내)액체복소후액체평형여양합지수적상관성,탐토조기액체복소대예후적영향.방법 채용관찰성연구,선택중국의과대학부속성경의원2011년3월지2013년10월수진혹입보통병방당일즉전입중증감호병방(ICU)적성인SAP환자97례,제외종지치료환자후,최종65례납입분석.소유환자유동일위ICU의생제정복소화치료계화병여이실시.안예후장환자분위호전조화사망조,비교량조환자입ICU후1、2、3、7、14d액체평형정황;병채용곡선의합방법고계매일액체평형량여양합지수적상관성.결과 납입적65례환자중,ICU치료기간사망12례,호전전입보통병방53례.호전환자루계액체평형증장추세감완혹출현부평형,이사망환자잉수액체정평형;호전조여사망조각시간단루계액체평형량(mL)차이균유통계학의의[1 d:1 814.5(905.2,2 152.8)비3 891.0(2 524.2,5 714.5),Z=-3.303,P=0.001;2 d:2 469.0(1 456.0,3 696.0)비6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001;3 d:3 234.0(1 098.0,4 295.5)비9 533.5(6 748.8,10 689.0),Z=-4.684,P＜0.001;7 d:3 234.0(1 033.0,5 162.0)비13 986.5(8045.8,14 518.0),Z=-4.718,P＜0.001; 14 d:3 234.0(978.5,4 924.0)비13 436.5(8 045.8,14 518.0),Z=-4.769,P＜0.001].경치료호전적환자입ICU 3 d내액체평형량여양합지수무명현상관성(R2=0.000,P=0.827);입ICU 3 d후양합지수여매일액체평형량지간만족logistic곡선의합,단의합도불고(R2=0.036,P＜0.001).결론 조기액체복소가유지SAP환자혈류동역학은정,능구조기실현액체상대부평형자예후교가,차호전환자3d후액체평형정황여양합지수부합logistic곡선의합.
Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P＜0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P＜0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P＜0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P＜0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU admission (R 2=0.000,P=0.827),and it fit the logistic curve in a relatively low level after 3 days of ICU admission (R 2=0.036,P＜0.001).Conclusions Early fluid resuscitation could help maintain hemodynamics stability in SAP patients.Those SAP patients who showed a negative equilibrium in early stage showed a better prognosis,and the fluid equilibrium and oxygen index in improved patients fit the logistic curve after 3 days of ICU admission.
