早期液体复苏终点指标对急性胰腺炎容量评估的价值

罗博文; 邓德海; 韦慧芬; 吴青; 唐国都; 梁志海

doi:10.3969/j.issn.1001-5256.2020.12.027

早期液体复苏终点指标对急性胰腺炎容量评估的价值

DOI: 10.3969/j.issn.1001-5256.2020.12.027

广西医科大学第一附属医院消化内科

基金项目:

国家自然科学基金（81970558）；广西自然科学基金（2017GXNSFAA198068）；

详细信息

中图分类号: R576
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出版历程
- 收稿日期: 2020-05-31
- 出版日期: 2020-12-20

Value of early fluid resuscitation endpoints in evaluating blood volume in patients with acute pancreatitis

Department of Gastroenterology,The First Affiliated Hospital of Guangxi Medical University

Research funding:

摘要

摘要:
目的探讨应用早期液体复苏终点指标对急性胰腺炎患者容量评估的价值。方法回顾性分析2003年-2016年广西医科大学第一附属医院收治的发病时间小于24 h且为初发初治的445例急性胰腺炎患者资料,依据液体复苏终点指标-血尿素氮（BUN）、红细胞压积（HCT）、平均动脉压（MAP）为标准分组,将患者分为达标组（MAP> 65 mm Hg、BUN<7. 14="" 0.="" n="219）、未达标组（MAP≤65" mm="" 7.="" hct="">0. 44或HCT<0. 35,n=226）;达标组代表容量正常,未达标组代表容量不足。比较两组患者症状、体征、病因、严重程度、并发症及预后的差异。计数资料2组间比较采用χ2检验或Fisher确切概率法,计量资料2组间比较采用Mann-Whitney U检验。结果未达标组WBC、BUN、胰腺CTSI值较达标组升高,差异均有统计学意义（Z值分别为-2. 85、-6. 725、-2. 293,P值均<0. 01）。局部并发症方面,达标组胰周渗出（45. 2%vs54. 9...
- 胰腺炎 /
- 血容量不足 /
- 血尿素氮 /
- 血细胞比容 /
- 动脉压
Abstract:
Objective To investigate the value of early fluid resuscitation endpoints in evaluating blood volume in patients with acute pancreatitis. Methods A retrospective analysis was performed for the clinical data of 445 previously untreated patients with acute pancreatitis who were admitted to The First Affiliated Hospital of Guangxi Medical University from 2003 to 2016 and had an onset time of less than 24 hours,and according the fluid resuscitation endpoints of mean arterial pressure( MAP),hematocrit( HCT),and blood urea nitrogen( BUN),the patients were divided into standard-reaching group( MAP > 65 mm Hg,BUN < 7. 14 mmol/L,and HCT ≥0. 35 and ≤0. 44,n = 219) and non-standard-reaching group( MAP ≤65 mm Hg or BUN ≥7. 14 mmol/L or HCT > 0. 44 or < 0. 35,n = 226).The standard-reaching group represented normal volume,while the non-standard-reaching group represented insufficient volume. The two groups were compared in terms of symptoms,signs,etiology,severity,complication,and prognosis. The chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of continuous data between two groups. Results Compared with the standard-reaching group,the non-standard-reaching group had significant increases in white blood cell count,BUN,and Computed Tomography Severity Index of the pancreas( Z =-2. 85,-6. 725,and-2. 293,all P < 0. 01). As for local complications,compared with the non-standard-reaching group,the standard-reaching group had significantly lower incidence rates of peripancreatic exudation( 45. 2% vs 54. 9%,χ2= 4. 15,P < 0. 05) and pancreatic necrosis( 10. 0% vs 18. 6%,χ2= 6. 59,P < 0. 05). As for systemic complications,compared with the non-standard-reaching group,the standard-reaching group had significantly lower incidence rates of acute respiratory distress syndrome( ARDS)( 0. 5% vs 4. 4%,χ2= 7. 26,P < 0. 05) and renal dysfunction( 1. 4% vs 6. 6%,χ2= 7. 95,P < 0. 05). The standard-reaching group had significantly lower proportion of patients with severe pancreatitis and hospital costs than the non-standard-reaching group( both P < 0. 05). Conclusion Fluid resuscitation endpoints can be used to evaluate the blood volume of patients with acute pancreatitis in the early stage after admission,and the patients not reaching the standard of fluid resuscitation tend to develop the complications such as peripancreatic exudation,pancreatic necrosis,ARDS,and renal dysfunction and may have higher hospital costs.
- pancreatitis /
- hypovolemia /
- blood urea nitrogen /
- hematocrit /
- arterial pressure

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