重症急性胰腺炎体液隔离病理生理特点的分析

目的 分析重症急性胰腺炎(SAP)体液隔离的病理生理特点.方法 回顾性分析新疆医科大学第一附属医院1995年1月至2000年1月53例SAP病人.按治疗结果分为早期死亡、晚期死亡、治愈3个组;统计3组入院后的前3d总人、出量和体液隔离量以及治疗48h前后3组红细胞压积(HCT)的变化.结果 ①早期死亡组和晚期死亡组体液隔离持续48h以上,早期死亡组、晚期死亡组和治愈组在48h体液隔离量分别为(10078.3±1616.2)ml、(6124.4±1081.1)ml和(4719.7±1397.7)ml,3组相比差异有显著性(P＜O.05);②治疗前HCT均高于正常值,治疗48h后3组HCT均下降,分别为(32.6±8.3)%、(37.5±4.1)%和(40.0±4.3)%,早期死亡组低于正常值范围,其中早期死亡组与治愈组相比差异有显著性(P＜O.05).结论 体液隔离并不是简单的体液丢失,其病理生理特点是细胞外液病理性再分布和细胞外液的液体量增加,尤其是组织间隙的液体量增加;而在量大时不仅有上述特点,血管内也存在体液隔离,导致容量负荷增加.

Analysis of pathophysiological features of fluid sequestration in severe acute pancreatitis

Objective To analyze the pathophysiological features of the fluid sequestration in severe acute pancreatitis(SAP).Methods A retrospective review was done on 53 cases with SAP treated in our hospital from January 1995 to January 2000.According to the outcome of treatment,the patients were divided into early death group,later death group and survival group.Fluid intake,fluid output and fluid sequestration were measured within the initial 72 h in the 3 groups.Hematocrit (HCT)before the therapy was compared with the change 48 h after the therapv.Results F1uid sequestration in early death group and later death group lasted for 48 h or more.The mean fluid sequestration within the initial 48h in the 3 groups was(10078.3±1616.2)ml,(6124.4±1081.1)ml and (4719.7±1397.7)ml,respectively.These changes were statistically different(P＜0.05).HCT exceeded normal range before treatment.Forty eight h after,HCT began to decrease,of which the numerical value was(32.6±8.3)%,(37.5±4.1)% and(40.0±4.3)%,respectively.Then it returned to normal range,and these changes were statistically different between early death group and survival group(P＜0.05).Conclusion Fluid sequestration is not just a kind of loss of fluid.The pathophysiological features of the fluid sequestration are pathological redistribution of extracellular fluid and expanding of extracellular fluid volume,especially in tissue interspace.A large amount of fluid sequestration not only has the features above,but also exists fluid sequestration in blood vessel and it may increase volume load.