探讨早期液体复苏对重症急性胰腺炎预后的影响

Impact of early fluid resuscitation on prognosis of patients with severe acute pancreatitis

摘要:

目的 将早期液体复苏应用于重症急性胰腺炎（SAP）的治疗，探讨其对重症急性胰腺炎的预后及影响。方法 选择2011年3月-2014年3月于该院治疗的78例SAP患者为研究对象，将患者分为观察组和对照组，每组39例。对照组患者采用常规的综合治疗，而观察组在综合治疗的基础上给予早期体液复苏。比较两组患者治疗后并发症的发生率及死亡率。结果 治疗1周后，观察组Ranson评分、APACHE II评分及CTSI 评分分别为（3.2±1.2）分、（9.2±2.6）分及（4.3±1.5）分，显著低于对照组（3.8±1.5）分、（10.4±2.1）分及（5.1±1.7）分，差异有统计学意义（P <0.05）。观察组死亡率为15.38%，显著低于对照组的（35.90%），差异有统计学意义（P <0.05）。观察组患者中，治疗3 d后死亡患者累计液体平衡仍持续增长，而好转患者累计液体平衡增长趋势减缓。结论 早期液体复苏可降低SAP患者的死亡率，能够早期达到液体相对负平衡的患者预后较佳。

Abstract:

【Objective】 To explore the effect of early fluid resuscitation on the prognosis of patients with severe acute pancreatitis (SAP). 【Methods】 The 78 SAP patients who received treatment in our hospital from Mar. 2011 to Mar. 2014 were selected for the study. They were divided into observation group and control group with 39 cases in each group. The patients in the control group were treated with routine comprehensive treatment and those in the observation group were given early fluid resuscitation on the basis of comprehensive treatment. The incidence of complications and mortality were compared between both groups after treatment. 【Results】 After one-week treatment, Ranson score, APACHE II score and CTSI score of the observation group were (3.2 ± 1.2), (9.2 ± 2.6) and (4.3 ± 1.5) points respectively, and were significantly lower than those of the control group [(3.8 ± 1.5), (10.4 ± 2.1) and (5.1 ± 1.7) points; P < 0.05]. Mortality rate of the observation group was 15.38% which was significantly lower than that of the control group (35.90%, P < 0.05). In the observation group, the cumulative fluid balance continued to grow in the death group after three-day treatment, but it began to stop growing in the improved group. 【Conclusions】 Early fluid resuscitation can reduce mortality of patients with SAP. The SAP patients who show a negative fluid equilibrium in early stage have a better prognosis.