重症急性胰腺炎体液隔离危害性的临床分析.DOCVIP

临床医学论文-重症急性胰腺炎体液隔离危害性的临床分析 ?????????? 作者：王喜艳 徐新建 韦军民 陈强 徐峰 栾梅香 【摘要】? 目的?? 分析重症急性胰腺炎（severe acute pancreatitis，SAP）体液隔离的危害。? 方法?? 回? 顾性分析我院1995年1月至2000年1月53例SAP临床资料。按治疗结果分为早期死亡、晚期死亡、? 治愈3个组;统计3组入院后的前3 d总出入量和体液隔离量以及治疗48 h前后红细胞压积（HCT）的? 变化;分析早期死亡和后期死亡的原因。? 结果?? 早期死亡组和晚期死亡组体液隔离持续48 h以上，早? 期死亡组、晚期死亡组和治愈组在48 h体液隔离量分别为（10 078.3±1 616.2）ml、（6 124.4±1 081.1）? ml和（4 719.7±1 397.7）ml，3组相比差异有统计学意义（?? P?? 0.05）。早期死亡6例，多与心脏骤停和? 呼吸衰竭有关;晚期死亡12例，多与感染有关。? 结论?? 体液隔离的实质是细胞外液病理性再分布和细? 胞外液增加。体液隔离的危害在早期为组织间隙体液大量急性贮留导致细胞、组织肿胀，心和肺功能受? 到致命的影响，在晚期增加感染的机会。 ??? 【关键词】?? 重症急性胰腺炎; 体液隔离; 细胞外液 ???【Abstract】 Objective? To analyse fluid sequestration in severe acute pancreatitis （SAP）. Methods A retrospective review was conducted of 53 patients with SAP between January 1995 and January 2000.?? According to the outcomes， the patients were divided into early death group， later death group and sur-? vival group. Fluid intake， fluid output and fluid sequestration were measured within initial 72 hours in?? the three groups. Results? Fluid sequestration in the early death group and later death group lasted for 48?? hours or more. The mean fluid sequestration within initial 48 hours in the three groups was （10 078.3±?? 1 616.2 ）ml， （6 124.4±1 081.1）ml and （4 719.7±1 397.7）ml， respectively. These changes were sta-? tistically different （?? P?? 0.05）. Six patients died of cardiac arrest and respiratory failure in the early?? death group， and twelve died of infection in the later death group. Conclusions? The essence of fluid se-? questration is pathological redistribution of extracellular fluid and expanding of extracellular fluid volume.?? A large amount of fluid storages acutely in interstitial space causes cell swelling and tissue edema， and?? may result in fatal influence on cardiac and pulmonary function. ??? 【Key words】? severe acute pancreatitis; fluid sequestration; extracellular fluid ??? 重症急性胰腺炎（severe acute pancreatitis，? SAP）发病凶险，是一种严重的全身性多器官损害? 性疾病。体液隔离（fluid sequestration）是临床判? 断SAP严重程度Ranson评分