重症急性胰腺炎早期液体治疗策略的探讨

目的探讨重症急性胰腺炎(SAP)早期两种不同液体治疗策略对患者预后的影响。方法回顾性分析我院2000年1月至2011年11月期间收治的符合入选标准且达到液体治疗目标的97例SAP患者,2000年1月至2004年12月期间收治的患者采用传统的液体治疗方法(简称传统治疗组,n=34),2005年1月至2011年11月期间收治的患者采取的早期目标指导的液体治疗策略(简称早期目标治疗组,n=63),比较2组间急性生理与慢性健康状况Ⅱ评分(APACHEⅡ)、器官功能不全评分(Marshall)、多器官功能障碍综合征(MODS)发生率、胰腺感染率和住院病死率的差异。结果与传统治疗组相比,早期目标治疗组患者液体治疗后第3天时的APACHEⅡ和Marshall评分较传统治疗组明显降低(APACHEⅡ评分:7.38±4.01比11.35±4.27,P=0.011;Marshall评分:4.13±2.06比6.82±3.15,P=0.016)。另外,早期目标治疗组患者入院后7 d内MODS发生率、胰腺感染率和住院病死率也较传统治疗组有所降低(MODS:46.0%比61.8%,P=0.139;胰腺感染率:31.7%比44.1%,P=0.226;住院病死率:15.8%比23.5%,P=0.355),但其差异均无统计学意义。结论本研究有限的病例结果提示,早期目标指导的液体治疗可在一定程度上缓解SAP病情,但能否改善SAP患者预后有待临床进行前瞻性随机对照研究。

Evaluation of Fluid Resuscitation Strategy for Severe Acute Pancreatitis in Early Stage

Objective To evaluate the effectiveness of fluid therapy on an early goal-directed approach to resuscitation basis and the standard fluid therapy of adequate resuscitation on the prognosis of severe acute pancreatitis(SAP)in early stage.Methods The clinical data of SAP patients admitted to surgical intensive care unit within 72 h after onset of symptoms from January 2000 to November 2011 were analyzed retrospectively.A total of 97 patients with a confirmed diagnosis of SAP were divided into two groups based on whether adopting the early goal-directed fluid resuscitation strategies or not.Patients admitted from January 2000 to December 2004 did not adopt the early goaldirected fluid resuscitation strategies,therefore,being allocated into standard fluid therapy group(n=34);patients admitted from January 2005 to November 2011 adopted the early goal-directed fluid resuscitation strategies and who were allocated into early goal-directed fluid therapy group(n=63).With the exception of the fluid therapy strategies,the two group patients received standard treatment for SAP.The acute physiology and chronic health evaluation Ⅱ score(APACHEⅡ)and multiple organ dysfunction score(Marshall),rate of multiple organ dysfunction syndrome(MODS) within the first week after admission,pancreatic infection rate,and in-hospital mortality were compared between the two groups.Results Compared with the standard fluid therapy group on day 3 after admission,APACHEⅡ score and Marshall score decreased significantly in the early goal-directed fluid therapy group(APACHE Ⅱ score:7.38±4.01 versus 11.35±4.27,P=0.011;Marshall score:4.13±2.06 versus 6.82±3.15,P=0.016).In addition,patients in the early goal-directed fluid therapy group experienced a trend toward lower rate s of MODS with the first week after admission,pancreatic infection,and in-hospital mortality(rate of MODS:46.0% versus 61.8%,P=0.139;rate of pancreatic infection:31.7% versus 44.1%,P=0.226;in-hospital mortality:15.8% versus 23.5%,P=0.355)that did not reach statistical significance.Conclusion Although early goal-directed fluid therapy for SAP in acute response stage may have ameliorated the patient’s condition and improved outcome to a certain degree,carefully designed human clinical trials should be performed in a randomized controlled manner to assess the role of such fluid resuscitation in SAP.