目的 探讨床旁超声指导液体复苏对重症急性胰腺炎(SAP)患者预后的影响.方法 选取2021年2月至2023年11月徐州医科大学附属沭阳医院收治的84例SAP患者,采用随机数字表法将其分为对照组和研究组,每组42例.对照组通过监测平均动脉压和中心静脉压进行液体复苏,研究组利用床旁超声监测进行液体复苏.比较两组各时间点补液量、急性生理和慢性健康评分Ⅱ(APACHEⅡ)评分及乳酸清除率,同时记录两组并发症、重症监护病房(ICU)住院天数、病死率.结果 两组＞24～48h和＞48～72h的输入液体量少于0～24 h,＞48～72 h输入液体量少于＞24～48 h,差异有统计学意义(P＜0.05);研究组0～24、＞24～48和＞48～72 h的输入液体量少于对照组,差异有统计学意义(P＜0.05).两组复苏24、48、72 h APACHE Ⅱ评分低于复苏前,复苏72 h APACHE Ⅱ评分低于复苏48、24 h,复苏48 h APACHE Ⅱ评分低于复苏24 h,差异有统计学意义(P＜0.05);研究组复苏24、48 hAPACHE Ⅱ评分低于对照组,差异有统计学意义(P＜0.05);两组复苏72 h APACHE Ⅱ评分比较,差异无统计学意义(P＞0.05).两组复苏48、72 h乳酸清除率高于24 h,复苏72 h乳酸清除率高于48 h,差异有统计学意义(P＜0.05);研究组复苏24、48 h乳酸清除率高于对照组,差异有统计学意义(P＜0.05);两组复苏72 h乳酸清除率比较,差异无统计学意义(P＞0.05).研究组胸腔积液、急性呼吸窘迫综合征、腹腔间隔室综合征占比低于对照组,ICU住院时间短于对照组,差异有统计学意义(P＜0.05).两组28 d死亡率比较,差异无统计学意义(P＞0.05).结论 床旁超声能更为精确地指导SAP患者液体复苏,改善患者APACHE Ⅱ评分、乳酸清除率、并发症发生率、ICU住院天数等.
Effect of bedside ultrasound guided fluid resuscitation on the prognosis of patients with severe pancreatitis
[Abstact]Objective To investigate the effect of bedside ultrasound-guided fluid resuscitation on the prognosis of patients with severe acute pan-creatitis(SAP).Methods A total of 84 SAP patients admitted to the Affiliated Shuyang Hospital of Xuzhou Medical University from February 2021 to November 2023 were selected and they were divided into control group and study group by random number table method,with 42 cases in each group.Mean arterial pressure and central venous pressure were monitored for fluid resuscitation in the control group,while bedside ultrasound monitoring was used for fluid resuscitation in the study group.The fluid volume,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and lactic acid clearance of the two groups were compared at each time point,and complications,intensive care unit(ICU)stay days and mor-tality were recorded.Results The amount of input liquid at 24-48 h and＞48-72 h was less than 0-24 h,and the amount of input liquid at＞48-72 h was less than＞24-48 h,and the differences were statistically significant(P＜0.05).The fluid intake of the study group at 0-24,＞24-48 and＞48-72 h were lower than those of the control group,the differences were statistically significant(P＜0.05).The APACHE Ⅱ scores at 24,48 and 72 h of resuscitation were lower than those before resuscitation,the APACHE Ⅱ score at 72 h of resuscitation were lower than 48 and 24 h of resuscitation,and the APACHE Ⅱ scores at 48 h of resuscitation were lower than 24 h,the differences were statistically significant(P＜0.05).APACHE Ⅱ scores of the study group at 24 and 48 h after resuscitation were lower than those of the control group,the differences were sta-tistically significant(P＜0.05),there was no statistically significant difference of APACHE Ⅱ scores between the two groups at 72 h after resuscita-tion(P＞0.05).The lactic acid clearance rate at 48 and 72 h after resuscitation was higher than that at 24 h,and the lactic acid clearance at 72 h af-ter resuscitation was higher than that at 48 h,with statistical significances(P＜0.05).The lactic acid clearance rate of the study group at 24 and 48 h after resuscitation was higher than that of the control group,the difference was statistically significant(P＜0.05),there was no statistically significant difference of lactic acid clearance rate between the two groups at 72 h after resuscitation(P＞0.05).The proportion of pleural effusion,acute respi-ratory distress syndrome and abdominal compartment syndrome in the study group was lower than that in the control group,and the length of ICU stay was shorter than that in the control group,the differences were statis-tically significant(P＜0.05).There was no significant difference in 28 day mortality of the two groups(P＞0.05).Conclusion Bedside ultrasound can more accurately guide fluid resuscitation in SAP patients,and improve patients'APACHE Ⅱ.score,lactate clearance rate,complication rate,and ICU length of stay.
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