高渗盐水对重症急性胰腺炎患者血流动力学及血清炎症因子水平的影响

目的 观察高渗盐水对重症急性胰腺炎(SAP)患者的血流动力学及血清炎症因子水平的影响,为临床应用高渗盐水治疗SAP提供理论依据.方法 57例SAP患者完全随机分为对照组(28例)和高渗盐水组(29例).高渗盐水组患者入院后每天按4 ml/kg输入7.5％高渗盐水,对照组患者则在相同时段输入0.9％氯化钠溶液,余治疗相同.分别于入院时及治疗后1、3、7、14 d记录患者平均动脉压(MAP)、HR、中心静脉压(CVP)的变化；酶联免疫吸附法动态检测血清中肿瘤坏死因子α、白细胞介素10浓度,动态比浊法测定血清内毒素含量.结果 治疗后第1天和第7天,高渗盐水组MAP、CVP明显高于对照组(130±48)mm Hg(1 mm Hg=0.133 kPa)比(104±43)mm Hg,( 129±36) mm Hg比(104±31) mm Hg;(8.39±2.91)cm H2O(1 cm H2O =0.098 kPa)比(5.92±2.84) cm H2O,(8.82±2.69) cm H2O比(6.41±3.10) cmH2O,P＜0.05],而治疗后第3天,高渗盐水组HR明显高于对照组(98±19)次/min比(126±27)次/min,P＜0.05]；治疗后第14天,高渗盐水组内毒素、肿瘤坏死因子-α、白细胞介素-10水平明显低于对照组(2.70±0.13) ng/L比(3.25±0.30) ng/L,( 30.13±8.12) ng/L比(313.42±144.35) ng/L,( 586.45±14.54) ng/L比(412.72±48.55) ng/L,P＜0.01或P＜0.05].结论 高渗盐水可改善SAP患者的血流动力学状杰并能够抑制全身炎症反应,对SAP的治疗有积极的意义.

The effect of hypertonic saline on hemodynamics and inflammatory cytokines in severe acute pancreatitis

Objective To study the effect of hypertonic saline treatment on hemodynamics and inflammatory cytokines in severe acute pancreatitis.Methods A total of 57 severe acute pancreatitis were randomized into hypertonic saline group ( n =27 ) and control group ( n =28 ).Hypertonic saline group received intravenously 4 ml/kg of 7.5％ hypertonic saline and control group received 0.9％ physiological saline after admission.Blood and urine amylase levels and WBC count were analyzed before admission and 1,3,7 and 14 days after treatment.The blood plasma endotoxin,tumor necrosis factor( TNF)-α,interleukin( IL)-10 levels and mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP) were measured at the same time.Results One and seven days after treatment,the MAP and CVP in hypertonic saline group were significantly higher than those in the control group (130±48)mmHgvs (104±43)mm Hg,(129±36)mm Hgvs (104±31)mm Hg;(8.39±2.91)cm H2Ovs (5.92 ±2.84)cm H2O,(8.82 ±2.69)cm H2O vs (6.41 ±3.10)cm H2O,P ＜0.05].The HR in hypertonic saline group was significantly lower than that in the control group after treatment of 3 days (98 ± 19) times/min vs ( 126 ±27)times/min,P ＜0.05].After treatment of 14 days,the serum levels of plasma endotoxin,TNF-α,IL-10 in hypertonic saline group were significantly lower than those in the control group (2.70 ±0.13) ng/L vs (3.25 ± 0.30) ng/L,(30.13 ±8.12) ng/L vs (313.42 ± 144.35) ng/L,(586.45 ± 14.54) ng/L vs (412.72 ±48.55) ng/L,P＜0.01 or P ＜0.05].Conclusions Hypertonic can improve the hemodynamics of severe acute pancreatitis patients and reduce endotoxin, TNF-α level in plasma. Hypertonic has an positive effect on severe acute pancreatitis.