容量复苏后液体正负平衡对急性重症胰腺炎的影响.pdfVIP

…1ìiII_眩_I)I!!.植噩~坦… 容量复苏后液体正负平衡对急 性重症膜腺炎的影响 委雪萍郑贞苍余玲丽陈鹏 【 摘要 】 目的 探讨容量复苏达标后液体正负平衡对急性重症膜腺炎(SAP)的影响。 方法 选择经持续肾替代治疗(CR- RT)的 SAP 患者 42 例，根据复苏达标后 48h 液体出入量分为正平衡组及负平衡组，记录并比较复苏达标后 0、24、48h 血流动力学指 标、血管外肺水指数(EVLWI )、肺血管通透性指数(PVP I )、氧合指数(PO:/Fi02 )、膀脱内压( IAP)、血浆脑纳肤(8NP)、血乳酸及每 24h 液体出入量、 ICU 住院时间、机械通气时间、CRRT 时间。 结果 负平衡组较正平衡组 ICU 住院时间、机械通气时间短(均 PO.05)。 CRRT 时间两组间差异无统计学意义(PO.05)。 容量复苏后 24、 48h 负平衡组 EVLWI 、 IAP、血乳酸均低于正平衡组(均 PO.05) ， PO:/Fi02 高于正平衡组(均 PO.O日， 8NP 在 48h 低于正平衡组(P0.05)。 结论 SAP患者容量复苏达标后宣采用适度液体负平 衡策略。 【关键词 1 容量管理液体复苏重症膜腺炎 EffeclS of liquid positive or negative balance on severe aCUte pancreatitis after fluid resuscitation LOU Xueping , ZHENG Zhencang, 只J Lingli, et al. Department 01 Critical Care Medicine , Taizhou Enzhe Medical Center Luqiao Hospiral, Taizhou 318050, China Absrract ] Objective To investigate the effects of different fluid management for severe acute pancreatitis( SAP )after flu- id resuscitation. Methods Forty two patients with SAP treated by continuous renal replacement therapy(CRRT )were classified as positive(n=18) and negative groups(凡=24) ， according to liquid intake and output a负er 48h of resusc itation . 有1e hemodynamic in- dexes, extravascular lung water index (EVLWI), pulmonary vascular permeability index, oxygenation index (POJFiO~， bladder pressure(ICP), 8-type natriuretic peptide(8NP), b l∞d lactic acid , liquid intake and output every 24h, the length of ICU stay, me- chanical ventilation and CRRT were documented and compared between two groups. Results The length of ICU stay and me- chanical ventilation in negative group was shorter than those in positive group(P 0.05). There was no significant d ifference in the length of CRRT between two gr∞ps(P 0.05). At 24, 48h after resuscitation, EVLWI, ICP, b l∞d lactic acid in negative group were lower and PO:/Fi0 2 was higher than those in positive group(P 0.05); 8NP in negative group was lower than that in pos tive group at 48h (P 0 .05). Conclusion Liquid negative balance wωId be bene