静脉注射6%羟乙基淀粉130/0.4和呋噻米对急性胰腺炎的扩容效果观察

目的观察静脉输注6%羟乙基淀粉130/0.4（万汶）和静脉推注呋噻米（速尿）对急性胰腺炎转归的影响。方法116例急性胰腺炎患者入院当日即给予6%羟乙基淀粉130/0.4静脉输注（成人通常为1000～2000ml）,次日开始逐渐减少其用量;在输注6%羟乙基淀粉130/0.4的同时静脉推注呋噻米,力求作到出入量基本平衡。结果应用6%羟乙基淀粉和呋噻米1～3天后,血容量恢复正常;99例患者痊愈后的血细胞压积（Hct）为33.6±5.7,显著低于入院时的41.6±6.9（t=13.359,P〈0.05）;血浆白蛋白浓度为（33.2±7.8）g/L,与入院时（36.3±8.2）g/L比较,差异无显著性意义（t=2.019,P〉0.05）;局部并发症发生率仅5%,全身并发症发生率6%,胰腺手术率4%。结论静脉注射6%羟乙基淀粉130/0.4和呋噻米可改善急性胰腺炎的转归,血浆外渗是急性胰腺炎的中心事件和治疗重点。

The volume-expanding effect of 6% hydroxyethylstarch 130/0.4(Voluven) and furosemide in the treatment of acute pancreatitis

Objective To observe the effects of intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide on the outcome of acute pancreatitis patients. Methods 116 patients （54% of patients With a Ranson＇s score≥3 and 59% With a Balthazar CT≥D） admitted to our center were given intravenous infusions of hydroxyethylstarch （1000―2000 ml administered for an adult） soon after admission. At the same time,furosemide was administered as intravenous bolus,trying to maintain a fluid balance. The amount of hydroxyethylstarch administered was gradually reduced from the second day after admission. Results Blood volume was restored within 1～3 days after admission. Hematocrit after recovery 33.6±5.7 was significantly lower than that on admission 41.6±6.9（P 0.05）. Plasma albumin concentration after recovery （33.2±7.8） g/L was slightly lower than that on admission （36.3±8.2） g/L. Only 5% and 6% patients developed pancreatic and systemic complications respectively;In-hospital mortality rate was 3%. Conclusion Our study suggested that intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide might be beneficial for acute pancreatitis patients. Plasma extravasation is a central event of acute pancreatitis,and the reversal of hypovolemia is crucial for the success of treatment of acute pancreatitis.