摘要
目的 探讨不同低晶胶比液体复苏完成时限在成人重症急性胰腺炎休克中的应用效果.方法 回顾性选取本院2021年5月-2024年4月收治的119例重症急性胰腺炎休克患者为研究对象,入院后均行低晶胶比液体复苏,并依据复苏完成时限分为≤1 h组(n=42)、＞1～2 h组(n=40)、＞2 h组(n=37).比较3组复苏前后中心静脉压(CVP)、平均动脉压(MAP)、心指数、动脉血二氧化碳分压[pa(CO2)]、pH值、动脉血氧分压[pa(O2)]、血乳酸、肺血管通透性指数(PVPI)、血管外肺水指数(ELWI)以及呼吸支持、去甲肾上腺素剂量、液体复苏量、ICU住院时间、生存率、急性生理和慢性健康状况Ⅱ(APACHE Ⅱ)评分、序贯脏器衰竭(SOFA)评分.结果 与＞2h组比较,≤1 h组、＞1～2h组复苏后MAP、CVP、心指数升高,差异有统计学意义(P＜0.05);与复苏前相比,复苏后3组pa(O2)均升高,pa(CO2)、血乳酸、pH值均降低,差异有统计学意义(P＜0.05);复苏后≤1h组和＞1～2h组血乳酸、去甲肾上腺素剂量、APACHE Ⅱ评分、SOFA评分均较＞2 h组降低,差异有统计学意义(P＜0.05);≤≤1h组、＞1～2 h组、＞2h组液体复苏量呈下降趋势,差异有统计学意义(P＜0.05);≤1h组有创呼吸支持患者比率及ICU住院时间较＞1～2 h组和＞2 h组更高更长,差异有统计学意义(P＜0.05);复苏后≤1 h组ELWI、PVPI较复苏前升高,差异有统计学意义(P＜0.05);复苏后≤1h组ELWI、PVPI高于＞1～2 h组、＞2 h组,差异有统计学意义(P＜0.05);≤1 h 组、＞1～2 h 组、＞2 h 组 30 d 生存率分别为 85.71％(36/42)、97.50％(39/40)、97.30％(36/37),＞1～2 h组和＞2 h组30 d生存率高于≤1h组,差异有统计学意义(P＜0.05).结论 低晶胶比液体复苏＞1～2 h为重症急性胰腺炎患者最佳完成时限,更有利于改善患者血流动力学、动脉血气指标,促进患者病情转归.
Abstract
Objective To explore the application effects of different completion time for low crystalloid-to-colloid ratio fluid resuscitation in treatment of adult patients with severe acute pancreati-tis complicated with shock.Methods A retrospective analysis was conducted in 119 patients with severe acute pancreatitis complicated with shock in the hospital from May 2021 to April 2024.All the patients underwent low crystalloid-to-colloid ratio fluid resuscitation and were divided into ≤1 h group(n=42),＞1 to 2 h group(n=40),and＞2 h group(n=37)based on the completion time of re-suscitation.Differences were compared among the three groups in terms of central venous pressure(CVP),mean arterial pressure(MAP),cardiac index,arterial partial pressure of carbon dioxide[pa(CO2)],pH value,arterial partial pressure of oxygen[pa(O2)],blood lactate,pulmonary vas-cular permeability index(PVPI),extravascular lung water index(ELWI)as well as respiratory sup-port,dose of norepinephrine,fluid resuscitation volume,length of stay in ICU,survival rate,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and Sequential Organ Failure Assessment(SOFA)score before and after resuscitation.Results Compared with the＞2 h group,the MAP,CVP and cardiac index increased significantly in the ≤ 1 h group and the＞1 to 2 h group after resuscitation(P＜0.05);compared with pre-resuscitation,the pa(O2)increased significantly while the pa(CO2),blood lactate and pH values decreased significantly in all the three groups after resuscitation(P＜0.05);after resuscitation,the blood lactate,dose of norepinephrine,APACHE Ⅱscore,and SOFA score were significantly lower in the ≤1 h group and the＞1 to 2 h group when compared with the＞2 h group(P＜0.05);there was a decreasing trend in fluid resuscitation vol-ume among the ≤ 1 h group,＞1 to 2 h group,and＞2 h group,with significant between-group differences(P＜0.05);the rate of patients requiring invasive respiratory support and length of stay in ICU in the≤1 h group were significantly higher and longer than those in the＞1 to 2 h group and the＞2 h group(P＜0.05);after resuscitation,the ELWI and PVPI increased significantly com-pared with pre-resuscitation in the ≤1 h group(P＜0.05);the ELWI and PVPI were significantly higher in the ≤ 1 h group than those in the＞1 to 2 h group and the＞2 h group after resuscitation(P＜0.05);the 30-day survival rates in the ≤ 1 h group,＞1 to 2 h group,and＞2 h group were 85.71％(36/42),97.50％(39/40),and 97.30％(36/37)respectively,and the 30-day sur-vival rate in the＞1 to 2 h group and the＞2 h group was significantly higher than that in the 1 h group(P＜0.05).Conclusion A completion time for low crystalloid-to-colloid ratio fluid re-suscitation of＞1 to 2 h is optimal for patients with severe acute pancreatitis,which is more benefi-cial in improving hemodynamics and arterial blood gas indicators as well as promoting patients'out-comes.
维普
万方数据