早期液体复苏对重症急性胰腺炎患者疗效的影响

目的 探讨早期液体复苏对重症急性胰腺炎(SAP)患者治疗效果的影响.方法 将发病72 h内就诊的70例SAP患者纳入研究.液体复苏达标参数:心率＜120次/min;尿量≥1 ml·h-1 ·kg-1；血细胞比容≤35％；平均动脉压65～85 mmHg(1 mmHg =0.133 kPa).回顾分析液体复苏达标时间(＜48h、48 ～72 h、＞72 h)和达标项目数(0～1、2、3、4项)对患者疗效的影响.结果 70例患者中41例(58.6％)发生并发症,20例(28.6％)中转手术,10例(14.3％)病死.中位住院天数为23.5 d,中位治疗费用为7.19(0.57～56.74)万元.＜48 h、48～72 h、＞72 h液体复苏达标患者的中转手术率(20.0％、33.3％、75.0％)、急性肾损伤发生率(20.0％、25.0％、75.0％)和并发症发生率(50.0％、83.3％、100％)在3组间均有统计学意义(P＜0.05).发病48 h内液体复苏后0～1、2、3、4项达标者的中转手术率(50.0％、26.3％、13.0％、25.0％)、急性肾损伤发生率(45.0％、31.6％、17.4％、0)、ARDS发生率(35.0％、31.6％、13.0％、0)均呈显著下降趋势.结论 SAP发病48 h内,合理的液体复苏策略有利于提高疗效,改善患者预后.

Effect of early fluid resuscitation on the prognosis of severe acute pancreatitis

Objective To investigate the effect of early fluid resuscitation on the prognosis of SAP patients.Methods Patients who were admitted to our hospital within 72 h after the onset of the SAP were enrolled.The parameters for the fluid resuscitation were as follow: heart rate ＜120 beat/h,urine output ≥ 1 ml ·h-1 · kg-1,hematocrit ≤35％ and mean arterial pressure 65 ～ 85 mmHg ( 1 mmHg =0.133 kPa).The effects of different time of reaching fluid resuscitation ( ＜48 h,48 -72 h,＞72 h) and parameters achieved (0 ～ 1parameter,2 parameters,3 parameters,4 parameters) on the prognosis were analyzed.Results There were 70 patient enrolled in this study and 41 ( 58.6％ ) developed complications,20 ( 28.6％ ) were referred to surgical operation and 10( 14.3％ ) died.The median hospital stay was 23.5 d,and the median medical cost was 71.9(5.7～567.4 thousands RMB).The rates of surgical intervention in ＜48 h,48 ～72 h,＞72 h groups were 20.0％,33.3％,75.0％,and the rates of acute kidney injury were 20.0％,25.0％,75.0％,while the rates of complications were 50.0％,83.3％,100％,and the difference among the 3 groups was statistically significant (P ＜ 0.05 ).The rates of surgical intervention in patients achieving 0 ～ 1,2,3,4parameters within 48h of SAP onset were 50.0％,26.3％,13.0％,25.0％,and the rates of acute kidney injury were 45.0％,31.6％,17.4％,0,while the rates of ARDS were 35.0％,31.6％,13.0％,0,which showing a significant decreasing trend.Conclusions An appropriate fluid resuscitation in the first 48 h after the onset of SAP was benefit for improving the treatment effects and patients' outcome.