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.%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。
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