CRRT联合限制性液体复苏对重症急性胰腺炎患者腹内压的影响

摘要

Objective To evaluate the effect of CRRT and limited fluid resuscitation on intra-abdominal pressure of patients with severe acute pancreatitis. Methods 42 patients admitted to ICU from 2005.1 to 2010.11 with severe pancreatitis, who were randomly divided into two groups according to the different treatrment methods and prospective controlled study were performed, I group executed an open fluid resuscitation, while II group carried out CRRT and limited fluid resuscitation, and the other basis of conventional therapy were the same, We analyzed the intm-abdominal pressure, blood lactate, APACHEII score before and after treatment by the first day, third day, fifth day and the amount of fluid resuscitation standards, ACS needs surgery decompression of the number of cases. Results The first group needed more fluid than the second group (7540 ± 250ml vs 4200 ± 165ml), more patients needed surgeries to decompression ( 6 cases vs 2 cases ), and also Ⅰ group' s the intra-abdominal pressure and APACHEII score were higher than Ⅱ group' s. All the P value above were less than 0.05. While thc blood lactate of two groups had decreased, but the difference was not significant. Conclusion CRRT combined limited fluid resuscitation is an effective method to treat early SAP, which could achieve target of liquid resuscitation with less liquid, little impact on intm-abdominal pressure, and low proportion of patients require surgical decompression.%目的 探索CRRT联合限制性液体复苏对重症急性胰腺炎患者早期腹内压的影响.方法 选择2005年1月至2010年11月我院收住ICU的重症胰腺炎患者42例,根据治疗方法不同随机分为两组,Ⅰ组采用重症胰腺炎常规治疗,开放性液体复苏;Ⅱ组在常规治疗的基础上采用CRRT 3 d及限制性液体复苏,监测治疗前、治疗后1 d、3 d、5 d的腹内压、血乳酸、APACHEⅡ评分,计算复苏达标时液体总量、ACS需手术减压病例数.结果 Ⅰ组复苏液体量为(7 540±250)ml,Ⅱ组复苏液体量为(4200±165)ml,两组比较P<0.05.Ⅰ组腹内压较Ⅱ组明显增高,P<0.05;Ⅰ组的APACHEⅡ评分高于Ⅱ组,P<0.05;Ⅰ组需手术减压患者6例,Ⅱ组手术减压2例,P<0.05;Ⅱ组较Ⅰ组血乳酸低,差异无统计学意义.结论 CRRT联合限制性液体复苏能达到复苏效果,对患者的腹内压影响小,需要手术减压患者比例低,是SAP早期治疗的有效方法.