静脉注射6%羟乙基淀粉130/0.4和呋噻米进行急性胰腺炎的液体复苏

目的观察静脉输注6%羟乙基淀粉130/0.4和静脉推注呋噻米（速尿）对急性胰腺炎患者转归的影响。方法 2007年10月16日-2010年3月15日收治的患者,入院当日即静脉输注羟乙基淀粉（成人通常为1000~2000ml）,在输注羟乙基淀粉的同时静脉推注呋噻米,力求作到出入量基本平衡;入院次日开始逐渐减少羟乙基淀粉用量。结果 218例急性胰腺炎患者（Ranson评分≥3分者54%,Balthazar CT评分≥D者65%）,胰腺局部并发症和全身并发症仅为15%和12%,胰腺手术率为3%,住院病死率为4%。通过比较入院时和痊愈后的血细胞压积,估计入院时血容量减少平均约17.7%。结论静脉输注羟乙基淀粉和静脉推注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。

Fluid therapy of acute pancreatitis patients with 6% Hydroxyethylstarch 130/0.4 and Furosemide

Objective This study was conducted to observe the effects of intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide on the outcome of acute pancreatitis patients.Patients admitted to our center from October 16,2007 through March 15,2010 were given intravenous infusions of 6% hydroxyethylstarch 130/0.4 solution（1000～2000ml administered for an adult） soon after admission.At the same time,fuorosemide was administered as intravenous bolus,trying to maintain a fluid balance.The amount of hydroxyethylstarch administered gradually decreased from the second day after admission.218 patients（54% of patients with a Ranson＇s score≥3 and 65% with a Balthazar CT score≥D） were treated with our protocol.Only 5% and 12% patients developed pancreatic and systemic complications respectively,only 1 patient undergone necrosectomy,and in-hospital mortality rate was 4%.It was estimated that on average 17.7% of blood volume was lost on admission.Our study suggested that intravenously administered 6% hydroxyethylstarch 130/0.4 solution and furosemide might be beneficial for patients with acute pancreatitis.Plasma extravasation is a central event of acute pancreatitis.The reversal of hypovolemia is crucial for the success of treatment of acute pancreatitis.