重症急性胰腺炎早期液体治疗与中转手术率的关系探讨

目的探讨重症急性胰腺炎患者早期液体治疗与中转手术率的关系。方法回顾性分析2005年7月至2010年6月华西医院ICU收治的重症急性胰腺炎患者，统计入ICU第一天、前两天及前三天累计液体平衡，分别根据四分位截断将患者进行分组，比较各组患者的人科基本情况，死亡率及中转手术率。结果共纳入患者208例，根据液体平衡的四分位截断值将患者分为〈25％组、25％～50％组、50％～75％组及〉75％组。随着累计液体平衡量的增多，患者中转手术率先逐渐下降，然后逐渐上升，以25％－50％组最低，与其他组比较差异有统计学意义（P〈0．05）；各组中以〉75％组死亡率、人ICU 24h急性生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及48hAPACHEⅡ评分最高，与其他组比较差异有统计学意义（P〈0．05），而其余三组间无显著差异。年龄、性别、Ranson评分及序贯器官衰竭评估（SOFA）评分，组间无显著差异（P〉0．05）。结论重症急性胰腺炎早期合理液体治疗可减少后期中转手术率及死亡率。

The Relationship Between Early Fluid Management and Conversion Rate to Surgery in Patients with Severe Acute Pancreatitis

Objective To investigate the relationship between early fluid management and the conversion rate to surgery in patients with sever acute pancreatitis （SAP）. Methods The patients with SAP admitted in ICU in West China Hospital from July 2005 to June 2010 were retrospectively analyzed. They were divided into four groups according to the quartile of the accumulated fluid balance in the first three days after admission in ICU （ 〈 25% , 25% - 50% , 50% - 75% , and 〉 75% , respectively）. The major demographic data, clinical characteristics, mortality, and conversion rate to surgery were evaluated respectively. Results 208 patients were enrolled. For each quartile, the conversion rate to surgery decreased at first, and then increased along with the increase of the accumulated fluid balance. Significant difference existed between the second quartile with the lowest conversion rate to surgery and other three quartiles （ P 〈 O. 05 ）. Differences were also found in mortality and the score of acute physiology and chronic health evaluation ]/（ APACHE I1 ） on 24th and 48th hour between the first three quartiles and the last quartile with the highest mortality and APACH 11 score （ P 〈 O. 05 ）. However, sex ratio, age, Ranson criteria, and the score of sequential organ failure assessment（SOFA） did not have significant differences among each quartile（ P 〉 0.05）. Conclusion Fluid management in early stage can influence conversion rate to surgery and mortality in patients with SAP.