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早期液体复苏终点指标对急性胰腺炎容量评估的价值
Value of early fluid resuscitation endpoints in evaluating blood volume in patients with acute pancreatitis
文章发布日期:2020年11月13日  来源:  作者:罗博文,邓德海,韦慧芬,等  点击次数:2681次  下载次数:38次

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【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 mmol/L且0.35≤HCT≤0.44,n=219)、未达标组(MAP≤65 mm Hg或BUN≥7.14 mmol/L或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χ 2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% vs 54.9%)、胰腺坏死(10.0% vs 18.6%)发生率较未达标组显著降低,差异均有统计学意义(χ2值分别为4.15、6.59,P值均<0.05)。全身并发症方面,达标组发生急性呼吸窘迫综合征(0.5% vs 4.4%)、肾功能损害(1.4% vs 6.6%)较未达标组低,差异均有统计学意义(χ2值分别为7.26、7.95,P值均<0.05)。达标组重症急性胰腺炎比例、住院费用明显低于未达标组(P值均<0.05)。 结论 急性胰腺炎患者入院早期可使用液体复苏终点指标评估患者容量状态,液体复苏未达标患者更易出现胰周渗出、胰腺坏死、ARDS、肾功能损害等并发症,住院费用更高。
【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.
【关键字】:胰腺炎; 血容量不足; 血尿素氮; 血细胞比容; 动脉压
【Key words】:pancreatitis; hypovolemia; blood urea nitrogen; hematocrit; arterial pressure
【引证本文】:LUO BW, DENG DH, WEI HF, et al. Value of early fluid resuscitation endpoints in evaluating blood volume in patients with acute pancreatitis[J]. J Clin Hepatol, 2020, 36(12): 2777-2781. (in Chinese)
罗博文, 邓德海, 韦慧芬, 等. 早期液体复苏终点指标对急性胰腺炎容量评估的价值[J]. 临床肝胆病杂志, 2020, 36(12): 2777-2781.

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