中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
1期
48-51
,共4页
昌毓穗%傅华群%邹书兵%喻本桐%刘季春%夏亮%吕农华
昌毓穗%傅華群%鄒書兵%喻本桐%劉季春%夏亮%呂農華
창육수%부화군%추서병%유본동%류계춘%하량%려농화
胰腺炎,急性,重症%液体复苏%晶胶比%存活率
胰腺炎,急性,重癥%液體複囌%晶膠比%存活率
이선염,급성,중증%액체복소%정효비%존활솔
Severe acute pancreatitis%Fluid resuscitation%Crystalloid-colloid ratio%Survival rate
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24 h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24 h机械通气率、氧合指数、腹腔内压(IAP)、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24 h,高晶胶比组机械通气率显著高于中、低晶胶比组(68.4％比20.0％、23.1％,均P＜0.05),氧合指数(mm Hg,1 mm Hg=0.133 kPa)明显低于中、低晶胶比组(180.7±26.3比280.6±24.8、260.3±25.7,均P＜0.05),IAP(cm H2O,1cm H2O=0.098 kPa)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24 h,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72 h,高晶胶比组总液体量(ml)明显高于中、低晶胶比组(11 941±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,且采用中品胶比的控制性液体复苏策略效果最佳.
目的 探討不同晶膠比液體早期複囌對重癥急性胰腺炎(SAP)患者預後的影響.方法 迴顧性分析本院2001年1月至2011年12月47例SAP患者的臨床資料.以第一箇24 h液體晶膠比1.5和3為界,將患者分成低晶膠比組(晶膠比＜1.5,13例)、中晶膠比組(晶膠比1.5 ～3,15例)和高晶膠比組(晶膠比＞3,19例),觀察入院後液體複囌成功患者的第一箇24 h機械通氣率、氧閤指數、腹腔內壓(IAP)、第三間隙液體潴留量、液體複囌量參數及患者2週內存活率.結果 ①入院後第一箇24 h,高晶膠比組機械通氣率顯著高于中、低晶膠比組(68.4％比20.0％、23.1％,均P＜0.05),氧閤指數(mm Hg,1 mm Hg=0.133 kPa)明顯低于中、低晶膠比組(180.7±26.3比280.6±24.8、260.3±25.7,均P＜0.05),IAP(cm H2O,1cm H2O=0.098 kPa)明顯高于中、低晶膠比組(16.8±3.6比13.4±3.5、13.1±3.3,均P＜0.05),液體潴留量(ml)顯著高于中、低晶膠比組(2834±631比1887±282、1865±300,均P＜0.05),而中晶膠比組與低晶膠比組比較差異均無統計學意義(均P＞0.05).②入院後第一箇24 h,高晶膠比組輸註晶體液量(ml)明顯高于中、低晶膠比組(3611±798比2308±416、2124±477,均P＜0.05)；高、中晶膠比組膠體液量(ml)明顯低于低晶膠比組(993±233、948±140比1506±332,均P＜0.05):晶膠比值高晶膠比組(3.65±0.13)＞中晶膠比組(2.43±0.13)＞低晶膠比組(1.41±0.08,均P＜0.05).複囌後72 h,高晶膠比組總液體量(ml)明顯高于中、低晶膠比組(11 941±1161比9036±982、9400±1051,均P＜ 0.05).③高晶膠比組2週內存活率(36.8％)顯著低于中晶膠比組(86.7％,P＜0.05)和低品膠比組(61.5％,P＞0.05).結論 對SAP患者早期宜採用適噹晶膠比的控製性液體複囌,可減輕體液潴留和提高治愈率,且採用中品膠比的控製性液體複囌策略效果最佳.
목적 탐토불동정효비액체조기복소대중증급성이선염(SAP)환자예후적영향.방법 회고성분석본원2001년1월지2011년12월47례SAP환자적림상자료.이제일개24 h액체정효비1.5화3위계,장환자분성저정효비조(정효비＜1.5,13례)、중정효비조(정효비1.5 ～3,15례)화고정효비조(정효비＞3,19례),관찰입원후액체복소성공환자적제일개24 h궤계통기솔、양합지수、복강내압(IAP)、제삼간극액체저류량、액체복소량삼수급환자2주내존활솔.결과 ①입원후제일개24 h,고정효비조궤계통기솔현저고우중、저정효비조(68.4％비20.0％、23.1％,균P＜0.05),양합지수(mm Hg,1 mm Hg=0.133 kPa)명현저우중、저정효비조(180.7±26.3비280.6±24.8、260.3±25.7,균P＜0.05),IAP(cm H2O,1cm H2O=0.098 kPa)명현고우중、저정효비조(16.8±3.6비13.4±3.5、13.1±3.3,균P＜0.05),액체저류량(ml)현저고우중、저정효비조(2834±631비1887±282、1865±300,균P＜0.05),이중정효비조여저정효비조비교차이균무통계학의의(균P＞0.05).②입원후제일개24 h,고정효비조수주정체액량(ml)명현고우중、저정효비조(3611±798비2308±416、2124±477,균P＜0.05)；고、중정효비조효체액량(ml)명현저우저정효비조(993±233、948±140비1506±332,균P＜0.05):정효비치고정효비조(3.65±0.13)＞중정효비조(2.43±0.13)＞저정효비조(1.41±0.08,균P＜0.05).복소후72 h,고정효비조총액체량(ml)명현고우중、저정효비조(11 941±1161비9036±982、9400±1051,균P＜ 0.05).③고정효비조2주내존활솔(36.8％)현저저우중정효비조(86.7％,P＜0.05)화저품효비조(61.5％,P＞0.05).결론 대SAP환자조기의채용괄당정효비적공제성액체복소,가감경체액저류화제고치유솔,차채용중품효비적공제성액체복소책략효과최가.
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 fiom 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 ① In 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 ± 26.3 vs.280.6 ± 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 ± 631 vs.1887 ± 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 crystalloid (ml) in high ratio group was significantly larger than that in the middle ratio group and the low ratio group (3611 ± 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 ± 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±0.13,1.41±0.08,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 pancreatitis,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-colloid fluid resuscitation should be the optimal strategy.
