摘要
目的:探究不同液体选择对重症急性胰腺炎(Severe acute pancreatitis,SAP)早期液体复苏的疗效观察以及患者腹内压和肠道功能障碍的影响。方法:回顾性分析我院2018年1月至2020年12月收治的重症胰腺炎154例患者的各项临床资料,以不同液体复苏方式作为分组依据,将应用乳酸林格氏液(Lactated Ringers solution,LR)的患者设为单一组(n=74例),应用LR+6%羟乙基淀粉(Hetastarch,HES)的患者设为联合组(n=80例),比较两组患者血液净化(CBP)时间、机械通气时间、苏醒时间以及生化指标、腹内压和肠道功能。结果:①恢复情况比较:CBP时间、机械通气时间、苏醒时间:联合组血液净化时间、机械通气时间短于单一组、苏醒时间早于单一组(P<0.05)②腹腔内压力(intra abdominal pressure,IAP):不同时间点,两组IAP比较差异有统计学意义,存在时间及效应(P<0.01)。③白细胞介素10(IL-10)、白细胞(WBC)、血尿淀粉酶(AMS)、血清脂肪酶(LPS):联合组干预后的IL-10上升幅度大于单一组,WBC、AMS、LPS下降幅度均大于单一组(P<0.05)。④肠道功能障碍:干预后联合组患者出现腹痛、便秘、腹胀、腹部压痛发生率低于单一组患者(P<0.05)。⑤干预后联合组患者复苏有效率为(90.00%)高于单一组患者(81.08%),但无统计学意义,(χ^(2)=2.497;P=0.114>0.05)。结论:在SAP患者早期液体复苏中选择LR+6%羟乙基淀粉联合使用疗效更好,可促进SAP患者复苏,降低腹内压和肠道功能障碍,维持血浆胶体渗透压,维持酸碱平衡,可用于临床推广。
Objective:To explore the efficacy of different fluid selections on early fluid resuscitation of severe acute pancreatitis(SAP)as well as the influence on intra-abdominal pressure and intestinal dysfunction of patients.Methods:The various clinical data of 154 patients with severe pancreatitis admitted to the hospital between January 2018 and December 2020 were retrospectively analyzed.Different fluid resuscitation methods were used as the basis for grouping.The patients with Lactated Ringers solution(LR)were set as monotherapy group(n=74),and the patients with LR+6%hydroxyethyl starch(Hetastarch,HES)were selected as combination group(n=80).The continuous blood purification(CBP)time,mechanical ventilation time,wake-up time,biochemical indicators,intra-abdominal pressure and intestinal function were compared between the two groups.Results:①Comparison of recovery showed that the CBP time and mechanical ventilation time of combination group were shorter than those of monotherapy group,and the wake-up time of combination group was earlier(P<0.05).②At different time points,there was a statistically significant difference in the intra-abdominal pressure(IAP)between the two groups,with time-point effect(P<0.01).③In terms of interleukin 10(IL-10),white blood cells(WBC),blood urine amylase(AMS)and serum lipase(LPS),the increase of IL-10 after intervention in the combination group was greater than that in the monotherapy group,and the decrease of WBC,AMS and LPS of the combination group were greater(P<0.05).④As for intestinal dysfunction,the incidence rates of abdominal pain,constipation,abdominal distension and abdominal tenderness in combination group after intervention were lower compared with that in monotherapy group(P<0.05).⑤The 90.00%effective rate of resuscitation in combination group was higher than 81.08%in monotherapy group after intervention(χ^(2)=2.497;P=0.114>0.05).Conclusion:In the early fluid resuscitation of patients with SAP,LR+6%Hetastarch has a better efficacy.It can promote the resuscitation,r
作者
陈孟娥
莫翠毅
蔡曼妮
邱坚
CHEN Meng'e;MO Cuiyi(Qionghai People's Hospital, Hainan Qiongha 571400, China)
出处
《河北医学》
CAS
2022年第3期441-445,共5页
Hebei Medicine
基金
海南省卫生计生行业科研项目,(编号:19A200029)。
关键词
重症急性胰腺炎
液体复苏
腹内压
肠道功能障碍
复苏疗效
Severe acute pancreatitis
Fluid resuscitation
Intra-abdominal pressure
Intestinal dysfunction
Resuscitation efficacy
