应用羟乙基淀粉130/0.4液体复苏治疗重症急性胰腺炎患者的临床观察

目的:探讨羟乙基淀粉130/0.4(万汶)对重症急性胰腺炎(SAP)患者进行液体复苏的有效性和安全性。方法:我院2006年6月～2007年12月收治的40例未手术的急性重症胰腺炎患者,用随机单盲的方法分成两组,万汶组20例,林格液组2O例。两组均禁食、胃肠减压、纠正水电解质酸碱平衡紊乱、静脉营养支持、制酸、生长抑素及抗生素应用,其中万汶组每日万汶15 ml/kg静脉滴注,疗程5 d;林格液组每日林格液20 ml/kg静脉滴注,疗程5 d。观察两组疗效、血液流变学、凝血功能、肾功能以及肺部并发症。结果:万汶组治疗有效率高,肺部并发症发生率低,明显优于林格液组。万汶组血液流变学参数改善差异有显著性(P<0.05),而林格液组变化差异无显著性(P>0.05);两组的凝血功能和肾功能在复苏前后差异无显著性(P>0.05)。结论:万汶能快速有效地稳定血流动力学,改善血液流变学,可能更有利于改善胰腺微循环障碍,故可首先考虑用于SAP患者的液体复苏。

Clinical observation of voluven for fluid resuscitation in severe acute pancreatitis patients

Objective:To observe the effectiveness and safety of voluven(hydroxyethyl starch 130/0.4) for fluid resuscitation in severe acute pancreatitis(SAP) patients.Methods:Between June 2006 to December 2007 in our hospital,40 SAP patients with non-operative treatment,were randomly divided into voluven group and Ringer's solution group(n=20 per group).Both groups were fasting,gastrointestinal decompression,correcting acid-base balance of water and electrolyte disorders,intravenous nutritional support,inhibiting gastric acid,somatostatin and the use of antibiotics,of which voluven group 15 ml/kg daily intravenously for 5 d;Ringer's solution group 20 ml/kg daily intravenously for 5d.The efficacy,blood rheology,coagulation function,renal function and pulmonary complications were observed.Results:Voluven group had high efficiency and low incidence of pulmonary complications.The hemorheology parameters were improved in voluven group(P<0.05),but not in Ringer solution group(P>0.05).Blood coagulation and renal function were not changed after fluid resuscitation(P>0.05).Conclusion:Voluven could effectively and quickly maintain hemodynamic stability and improve the hemorheological status.It may be more conducive to improving the pancreatic microcirculation.Voluven should be considered firstly for fluid resuscitation in SAP patients.