CRRT治疗高脂血症性急性胰腺炎的容量管理研究

目的 研究连续肾脏替代治疗（CRRT）治疗高脂血症性急性胰腺炎时容量平衡对预后的影响。方法 回顾性分析2017年1月~2018年6月我院重症医学科收治的54例高脂血症重症胰腺炎患者，入住后均给予液体复苏，并予床旁CRRT治疗，液体复苏完成后，按照患者的出入量分成负平衡组（72 h液体入量＜出量）和正平衡组（72 h液体入量＞出量），收集两组患者年龄、性别、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭SOFA评分、血肌酐；比较两组氧合指数、白细胞（WBC）、C反应蛋白（CPR）、血乳酸、膀胱内压、机械通气时间、ICU住院时间及28 d病死率。结果 两组72 h乳酸、WBC、CPR水平比较，差异无统计学意义（P＞0.05）；负平衡组氧合指数大于正平衡组，膀胱压小于正平衡组，差异有统计学意义（P＜0.05）；负平衡组机械通气时间，ICU住院时间少于正平衡组，差异均有统计学意义（P＜0.05），两组28 d病死率比较，差异无统计学意义（P＞0.05）。结论 在高脂血症性急性胰腺炎时液体复苏完成后限制性容量管理可能对患者有益，患者的临床指标改善更快，预后更好。

Capacity Management of CRRT in the Treatment of Hyperlipidemic Acute Pancreatitis

Abstract:Objective To investigate the effect of volume balance on prognosis in patients with hyperlipidemic acute pancreatitis treated with continuous renal replacement therapy (CRRT).Methods A retrospective analysis of 54 patients with severe pancreatitis with hyperlipidemia admitted to our department of intensive care from January 2017 to June 2018 was given fluid resuscitation and bedside CRRT. After fluid resuscitation, The patients were divided into a negative balance group (72 h fluid intake < output) and a positive balance group (72 h fluid intake > output) according to the patient's inflow and outflow, and the age, sex, acute physiology and chronic health status scores of the two groups were collected. System II (APACHE II) score, sequential organ failure SOFA score, serum creatinine; comparison of oxygenation index, white blood cell (WBC), C-reactive protein (CPR), blood lactate, intravesical pressure, mechanical ventilation time, ICU hospitalization time and 28 d case fatality rate.Results There were no significant differences in the levels of 72 h lactic acid, WBC and CPR between the two groups (P>0.05). The oxygenation index of the negative balance group was greater than that of the positive balance group, and the bladder pressure was lower than the positive balance group,the difference was statistically significant (P<0.05). In the negative balance group, the mechanical ventilation time, ICU hospitalization time is less than the positive balance group,the differences were statistically significant (P<0.05). There was no significant difference in the mortality rate between the two groups at 28 d (P>0.05). Conclusion Restrictive volume management may be beneficial to patients after hyperlipidemia acute pancreatitis, and the patient's clinical indicators improve faster and the prognosis is better.