容量复苏后液体正负平衡对急性重症胰腺炎的影响

目的：探讨容量复苏达标后液体正负平衡对急性重症胰腺炎（SAP）的影响。方法选择经持续肾替代治疗（CR-RT）的SAP患者42例，根据复苏达标后48h液体出入量分为正平衡组及负平衡组，记录并比较复苏达标后0、24、48h血流动力学指标、血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）、氧合指数（PO2/FiO2）、膀胱内压（IAP）、血浆脑钠肽（BNP）、血乳酸及每24h液体出入量、ICU住院时间、机械通气时间、CRRT时间。结果负平衡组较正平衡组ICU住院时间、机械通气时间短（均P＜0.05）。CRRT时间两组间差异无统计学意义（P＞0.05）。容量复苏后24、48h负平衡组EVLWI、IAP、血乳酸均低于正平衡组（均P＜0.05）， PO2/FiO2高于正平衡组（均P＜0.05），BNP在48h低于正平衡组（P＜0.05）。结论 SAP患者容量复苏达标后宜采用适度液体负平衡策略。

Effects of liquid positive or negative balance on severe acute pancreatitis after fluid resuscitation

Objective To investigate the effects of different fluid management for severe acute pancreatitis（SAP）after flu-id resuscitation. Methods Forty two patients with SAP treated by continuous renal replacement therapy（CRRT）were classified as positive（n=18） and negative groups（n=24）, according to liquid intake and output after 48h of resuscitation. The hemodynamic in-dexes, extravascular lung water index （EVLWI）, pulmonary vascular permeability index, oxygenation index （PO2/FiO2）, bladder pressure（ICP）, B- type natriuretic peptide（BNP）, blood lactic acid, liquid intake and output every 24h, the length of ICU stay, me-chanical ventilation and CRRT were documented and compared between two groups. Results The length of ICU stay and me-chanical ventilation in negative group was shorter than those in positive group（P〈0.05）. There was no significant difference in the length of CRRT between two groups（P〉0.05）. At 24, 48h after resuscitation, EVLWI, ICP, blood lactic acid in negative group were lower and PO2/FiO2 was higher than those in positive group（P〈0.05）;BNP in negative group was lower than that in positive group at 48h （P〈0.05）. Conclusion Liquid negative balance would be beneficial for patients with severe acute pancreatitis after fluid resuscitation.