重症急性胰腺炎患者应用不同晶胶比液体早期复苏对预后的影响研究

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。方法选择94例SAP患者，以入院24h内液体晶胶比1．5和3．0为界，将患者分成低晶胶比组（晶胶比〈1．5，26例）、中晶胶比组（晶胶比1．5～3．0，30例）和高晶胶比组（晶胶比〉3．0，38例），观察入院后液体复苏成功患者24h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周内生存率。结果高晶胶比组24h晶体液量、晶胶比、第三间隙液体潴留量及72h输液总量高于中、低晶胶比组（3612±799）ml比（2309±417）、（2125±478）ml，（3．66±0．14）比（2．44±0．15）、（1．42±0．09），（2835±632）ml比（1889±283）、（1866±305）ml，（11942±1162）ml比（9037±983）、（9401±1052）m1]，差异有统计学意义（P〈0．05）；中晶胶比组24h晶胶比高于低晶胶比组，差异有统计学意义（P〈0．05）；低晶胶比组24h胶体液量高于高、中晶胶比组（1507±335）ml比（994±234）、（949±141）m1]，差异有统计学意义（P〈0．05）。中晶胶比组24h晶体液量、第三间隙液体潴留量及72h输液总量与低晶胶比组比较差异无统计学意义（P〉0．05）。高晶胶比组24h机械通气率、IAP明显高于中、低晶胶比组65．8％（25／38）比23．3％（7／30）、26．9％（7／26），（16．9±3．7）cmH2O（1emH20=0．098kPa）比（13．5±3．6）、（13．2±3．4）cmH2O]，24h氧合指数明显低于中、低晶胶比组（180．8±26．4）mmHg（1mmHg=0．133kPa）比（280．7±24．9）、（260．4±25．8）mmHg]，差异均有统计学意义（P〈0．05）；高晶胶比组2周内生存率为34．2％（13／38），低于中、低晶胶比组的86．7％（26／30）、57．7％（15／26），与中晶胶比组比较差异有统计学意义（P〈0．05），与低晶胶比组比较差异无统计学意义（P〉0．05）；低晶胶比组2周内生存率低于中晶胶比组，但差异无统计学意义（P〉0．05）。结论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，且采用中晶胶比的控制性液体复苏策略效果最佳。

The effect of initial fluid resuscitation with different ratio of crystalloid-colloid on prognosis of patients with severe acute pancreatitis

Objective To investigate the effect of initial fluid resuscitation with different liquid crystal glue ratio on prognosis of patients with severe acute pancreatitis （SAP）. Methods Ninety-four cases of SAP patients were selected, with the first 24 h liquid crystal glue ratio of 1.5 and 3.0 for the sector, were divided into low crystal glue ratio group （crystal glue ratio 〈 1.5, 26 cases）, microtek glue ratio group（crystal glue ratio 1.5 - 3.0, 30 cases） and high crystal glue ratio group （crystal glue ratio 〉 3.0, 38 cases）. 24 h mechanical ventilation rate, oxygenation index,intra-abdominal pressure （IAP）, third interstitial fluid retention, the parameters of fluid resuscitation and 2 week survival rate were observed in three groups. Results 24 h crystal solution volume, crystal glue ratio, third interstitial fluid retention and 72 h infusion volume in high crystal glue ratio group was higher than that in microtek glue ratio group and low crystal glue ratio group （3612 ±799） ml vs.（2309 ± 417）, （2125 ±478） ml, （3.66 ±0.14） vs.（2.44 ± 0.15）, （1.42 ±0.09）, （2835 ±632） ml vs. （1889 ±283）, （1866 ±305） ml, （11942 ± 1162） ml vs. （ 9037 ± 983 ）, （ 9401 ± 1052 ） ml ], and there were significant differences （P 〈 0.05 ）. 24 h crystal glue ratio in microtek glue ratio group was higher than that in low crystal glue ratio group, and there was significant difference（P〈 0.05 ）. 24 h glue volume in low crystal glue ratio group was higher than that in high crystal glue ratio group and microtek glue ratio group （1507 ± 335 ） ml vs. （994 ± 234）, （949 ± 141 ） ml ], and there were significant differences （P 〈 0.05 ）. There was no significant difference in 24 h crystal volume, third interstitial fluid retention and 72 h infusion volume between microtek glue ratio group and low crystal glue ratio group （P 〉 0.05 ）. 24 h mechanical ventilation rate, lAP in high crystal glue ratio group was higher than that in microtek glue ratio group and low crystal glue ratio group 65.8% （25/38） vs. 23.3%（7/30）, 26.9% （7/26）,（16.9±3.7）cmH20 （1 cmH2O=0.098kPa）vs. （13.5±3.6）, （13.2±3.4） cmH20], 24h oxygenation index was lower than that in micmtek glue ratio group and low crystal glue ratio group （ 180.8 ± 26.4） mm Hg （1 mm Hg =0.133 kPa） vs.（280.7 ±24.9）, （260.4 ±25.8） mm Hg], and there was significant difference （P 〈 0.05 ）. 2 week survival rate in high crystal glue ratio group was lower than that in microtek glue ratio group and low crystal glue ratio group 34.2% （13/38） vs. 86.7% （26/30）, 57.7% （ 15/26 ） 1, there was significant difference between high crystal glue ratio group and microtek glue ratio group （P 〈 0.05 ）, but there was no significant difference between high crystal glue ratio group and low crystal glue ratio group （P 〉 0.05 ）. There was no significant difference in 2 week survival rate between low crystal glue ratio group and microtek glue ratio group （P 〉 0.05 ）. Conclusion In early SAP patients should follow the appropriate crystal glue ratio controlled fluid resuscitation, reduce fluid retention and improve the cure rate, and the use of microtek glue ratio controlled fluid resuscitation strategy is best.