摘要：
目的 观察不同晶胶比液体早期复苏对中度重症急性胰腺炎(MSAP)患者预后的影响.方法 回顾性分析2015年1月至2017年7月间上海长海医院收治的72例MSAP患者临床资料,根据入院后7d内晶、胶液体补充总量比值将患者随机分为低晶胶比组(＜4.5)、中晶胶比组(4.5 ～7.5)和高晶胶比组(＞7.5).分析各组患者液体复苏参数及进展为重症急性胰腺炎(SAP)的例数、多脏器功能障碍综合征(MODS)发生率、机械通气率、胰腺坏死感染发生率、30 d病死率、全身炎症反应综合征(SIRS)持续时间、肠内营养达全量所需时间.结果 各组患者性别、年龄、病因、入院24h APACHEⅡ评分的差异均无统计学意义,具有可比性.3组7d的补液总量、整体补液速率差异无统计学意义.但与中晶胶比组比较,高晶胶比组24、72 h补液总量[(3095±1253)ml比(2524 ±751)ml,(8005 ±7269)ml比(6667±1498) ml]及入院7d内晶体液总量[(14 485 ±3 917) ml比(11 544 ±2 639)ml]、晶胶比(12.7 ±4.9比6.0±1.0)、进展为SAP例数(12比4)、MODS发生率(41.7％比16.0％)均显著增加,而7d胶体液总量显著下降[(996±528) ml比(1 968±574)ml],SIRS持续的时间[(16.5±15.2)d比(8.2±6.4)d]、肠内营养达全量所需的时间[(7.2±3.6)d比(4.8±2.5)d]均显著延长,差异均有统计学意义(P值均＜0.05),机械通气率、胰腺坏死感染发生率、30 d病死率的差异均无统计学意义.与中晶胶比组比较,低晶胶比组的7d胶体液总量显著增加[(3 680±1 310)ml比(1 968±574) ml]、晶胶液比值显著下降(3.2±0.9比6.0±1.0),其他指标的差异均无统计学意义.结论 对MSAP患者采用晶胶比为4.5 ～7.5的液体早期复苏,可降低患者进展为SAP、MODS发生率,减少SIRS持续时间,促进肠道黏膜屏障功能的恢复.%Objective To investigate the impact of the initial fluid resuscitation with different ratio of crystalloid and colloid on the prognosis of patients with moderate severe acute pancreatitis (MSAP).Methods A retrospective analysis was made by reviewing the clinical data of 72 patients with the diagnosis of MSAP from January 2015 to July 2017 in Shanghai Changhai Hospital.According to crystalloid-colloid ratio,which was the total volume of crystalloid fluid versus colloid fluid in the first 7d at admission,patients were randomly divided into low crystalloid-colloid ratio group (＜ 4.5),middle crystalloid-colloid ratio group (4.5-7.5),and high crystalloid-colloid ratio group (＞ 7.5).The parameters of the fluid resuscitation,the cases progressing into severe acute pancreatitis (SAP),the incidence of multiple organs dysfunction syndrome (MODS) and mechanical ventilation,pancreatic necrosis and infection rate,30-day mortality,the duration of systemic inflammatory response syndrome(SIRS) and the time reaching full amount of enteral nutrition were analyzed.Results There was no statistically significant difference in gender,age,etiology and APACHE Ⅱ score within 24 h at admission in each group,which were comparable.Within the first 7 d,there were no statistic difference in the total volume of fluid infusion and the speed of resuscitation in the three groups.While the total fluid volume in the first 24 h and 72 h [(3 095 ± 1 253) ml vs (2 524 ± 751) ml,(8 005 ± 7 269) ml vs (6 667 ± 1 498)ml],the total volume of crystalloid fluid in the first 7 d [(14 485 ± 3 917) ml vs (11 544 ±2 639) ml],crystalloid-colloid ratio (12.7 ± 4.9 vs 6.0 ± 1.0),the cases of SAP (12 vs 4),MODS (41.7 ％vs 16.0％) in high ratio group were significantly higher than those in middle ratio group,but the total volume of colloid fluid was significantly lower [(996 ± 528) ml vs (1 968 ± 574) ml].In addition,the duration of SIRS [(16.5 ± 15.2) d vs (8.2 ± 6.4) d],and the time reaching full amount of enteral nutrition [(7.2 ±3.6) d vs (4.8 ± 2.4) d] in high crystalloid-colloid ratio group were higher than those in middle crystalloid-colloid ratio group (all P ＜ 0.05).Comparing with middle crystalloid-colloid ratio group,there were no significant difference in the mechanical ventilation rate,pancreatic necrosis and infection rate and 30-day mortality in high ratio group.The total volume of colloid fluid was significantly higher [(3 680 ± 1 310) vs (1 968 ±574)] and the crystalloid-colloid ratio was significantly lower [(3.2 ±0.9) vs (6.0 ± 1.0)] in low ratio group than that in middle ratio group,and there were no statistical differences on other parameters.Conclusions For the patients with MSAP,early fluid resuscitation with the crystatloid-colloid ratio of (4.5-7.5) can decrease the incidence of SAP and MODS,shorten the duration of SIRS,and promote the recovery of intestinal mucosal barrier function.
