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早期限制性液体复苏联合中药治疗对重症急性胰腺炎转归的影响
Effect of early controlled fluid resuscitation combined with traditional Chinese medicine treatment on the prognosis of severe acute pancreatitis
文章发布日期:2017年09月07日  来源:  作者:黄涛, 姚红艳, 尔启东, 等  点击次数:166次  下载次数:23次

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【摘要】:目的探讨早期限制性液体复苏联合中药治疗对重症急性胰腺炎转归的影响。方法回顾性分析天津市西青医院2013年7月-2016年8月收治的48例重症急性胰腺炎患者的临床资料,根据治疗方式不同分为早期限制性液体复苏联合中药治疗(治疗组)26例和常规液体治疗组(对照组)22例。观察2组患者治疗72 h内液体输入总量、尿量、腹腔内压(IAP)、平均动脉压(MAP)、中心静脉压(CVP)、心率及各生化指标的变化,评估胃肠功能障碍及各并发症的发生情况。SAP严重程度评分、入院72 h内临床观察指标、治疗前后生化指标、胃肠功能障碍评分以及治疗后IAP水平等计量资料2组间比较采用t检验;并发症发生率比较采用χ2检验。结果治疗72 h内,2组患者红细胞比容(HCT)均达到早期目标性治疗要求,但治疗组较对照组降低,差异有统计学意义(t=2.188,P=0.034);治疗组的72 h输液总量较对照组少,差异有统计学意义(t=7.342,P<0001);心率方面治疗组明显好转,与对照组比较差异有统计学意义(t=6.315,P<0001)。治疗后ALT、AST、TBil、CRP、淀粉酶、脂肪酶、尿素氮、肌酐等生化指标改善方面治疗组均优于对照组,且差异均有统计学意义(t值分别3.420、2.170、2.700、3.330、6.960、12.590、2.400、2.740,P值分别为0001、0.035、0.010、0.002、<0001、<0001、0.020、0.009)。2组患者治疗后胃肠功能障碍评分较治疗前差异均具有统计学意义(P值均<0.05),且治疗组胃肠功能障碍评分更低,与对照组比较差异具有统计学意义(t=8.063,P<0001)。治疗后2组IAP比较,差异有统计学意义(t=2.200,P=0.033),且治疗组并发症(腹腔间隔室综合征、ARF、急性呼吸窘迫综合征、多脏器功能障碍综合征)发生率较低(15.38%),对照组并发症发生率高达5455%,并出现1例多脏器功能障碍综合征。结论早期限制性液体复苏联合中药治疗能够明显改善重症急性胰腺炎患者的胃肠功能障碍,减少并发症发生率,改善患者预后。
【Abstract】:ObjectiveTo investigate the effect of early controlled fluid resuscitation combined with traditional Chinese medicine (TCM) treatment on the prognosis of severe acute pancreatitis (SAP). MethodsA retrospective analysis was performed for the clinical data of 48 patients with SAP who were treated in our hospital from July 2013 to August 2016, and according to the treatment modality, the patients were divided into early controlled fluid resuscitation-TCM treatment group (treatment group with 26 patients) and conventional fluid therapy group (control group with 22 patients). The two groups were observed in terms of total liquid volume within 72 hours of treatment, urine volume, intra-abdominal pressure (IAP), mean arterial pressure (MAP), central venous pressure (CVP), and changes in heart rate and biochemical parameters, and the incidence of gastrointestinal dysfunction and related complications was evaluated. The continuous data, such as SAP severity score, clinical indices within 72 hours after admission, biochemical parameters before and after treatment, gastrointestinal dysfunction score, and IAP after treatment, were expressed as mean±SD (x±s), and the t-test was used for comparison of such data. The chi-square test was used for comparison of incidence rates of complications. ResultsWithin 72 hours of treatment, both groups achieved the early treatment requirements for hematocrit (HCT), and the treatment group had significantly lower HCT than the control group (t=2188, P=0.034). Compared with the control group, the treatment group had a significantly lower total liquid volume (t=7.342, P<0001) and a significantly greater improvement in heart rate (t=6.315, P<0001). After treatment, the treatment group had significantly greater improvements in biochemical parameters including alanine aminotransferase, aspartate aminotransferase, total bilirubin, C-reactive protein, AMY, lipopolysaccharide, blood urea nitrogen, and creatinine compared with the control group (t=3.420, 2.170, 2700, 3.330, 6.960, 12.590, 2.400, and 2.740, P=0.001, 0.035, 0.010, 0.002, 0, 0, 0.020, and 0.009). Both groups had a significant change in gastrointestinal dysfunction score after treatment (both P<0.05), and the treatment group had a significantly lower gastrointestinal dysfunction score than the control group (t=8.063, P<0001). There was a significant difference in IAP after treatment between the two groups (t=2200, P=0.033). The treatment group had a lower incidence rate of complications (abdominal compartment syndrome, acute renal failure, acute respiratory distress syndrome, and multiple organ dysfunction syndrome) than the control group (1538% vs 50%), and 1 patient in the control group experienced multiple organ dysfunction syndrome. ConclusionIn patients with SAP, early controlled fluid resuscitation combined with TCM treatment can significantly improve gastrointestinal dysfunction, reduce the incidence of complications, and improve the prognosis of such patients.
【关键字】:限制性液体复苏; 中药; 胰腺炎
【Key words】:limited fluid resuscitation; TCD; pancreatitis
【引证本文】:黄涛, 姚红艳, 尔启东, 等. 早期限制性液体复苏联合中药治疗对重症急性胰腺炎转归的影响[J]. 临床肝胆病杂志, 2017, 33(10): 1969-1973.

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