早期肠内途径液体复苏对重症急性胰腺炎患者的临床疗效
The enteral route using naso-jejunal fluid resuscitation in predicted severe acute pancreatitis

习晓丽.早期肠内途径液体复苏对重症急性胰腺炎患者的临床疗效[J].内科急危重症杂志,2016,22(3):

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英文关键词:Severe acute pancreatitis Organ failure Complication,oral rehydration solution.

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作者	单位	E-mail
习晓丽	四川省宜宾市第一人民医院消化内科	372092562@qq.com

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中文摘要:

目的：分析我院早期肠内途径液体复苏对急性重症胰腺炎（Severe acute pancreatitis，SAP）患者临床疗效。方法：回顾性分析2013年1月至2015年6月我院的95例早期SAP（BISAP评分>2）的临床资料，根据入院后24h内液体复苏途径将患者分成鼻肠管肠内途径复苏组（A组）与常规静脉途径复苏组(B组)。观察新器官衰竭发生率，病死率，并发症、住院时间以及不良反应。结果：A组3例患者因腹胀不耐受，予以剔除,余下92例患者均无严重电解质异常发生。两组患者在复苏前病情重症评分、HCT，腹内压等均无统计学差异。两组间HCT及腹内压变化，腹痛缓解及肠鸣音恢复时间均无统计学差异。A组早期肠内营养开始于2.5±4.3 天，明显早于B组5.92±6.4 (P＜0.05)。Marshall评分为器官衰竭(Marshall评分)标准，治疗8天A组新发器官衰竭6例（17.1%），B组新发器官衰竭20例(35.1%)（P＜0.05）。器官衰竭呈现持续性(＞36 h)A组12例(34.3%)，B组29例（50.9%）（P＜0.05）。胰腺感染或脓肿A组发生率为11.4%，显著低于B组19.3%（P＜0.05）。继续ICU监护A组13例（34.3%），显著低于B组32例（56.1%）（P＜0.05）。结论：早期重症急性胰腺炎患者，鼻肠管肠内途径容量复苏是可行的，有利于早期肠内营养，降低并发症。

英文摘要:

To confirm feasibility of naso-jejunal (NJ) fluid resuscitation using oral hydration solution (ORS) and compare its efficacy with intravenous (IV) fluid resuscitation using Ringer Lactate in predicted SAP. Methods: We retrospectively analyzed the clinical data of 95 cases of patients with early severe acute pancreatitis (BISAP score > 2) between January 2013 and June 2015 in our hospital。All patients of predicted SAP without significant comorbidities were randomized to IV group (RL infusion at same rate) or NJ group (ORS: 20 ml/kg for first hour and then 3 ml/kg/hour). The groups were compared persistent organ failure, mortality, complication and the length of hospital stays. Results: Ninety-five patients were assessed and after exclusion, Ninety-two patients were randomised to either NJ (35 patients) or IV group (57). The demographic and baseline clinical profile of both groups including BISAP score, intra-abdominal pressure, blood urea nitrogen and haematocrit were similar. NJ resuscitation had to be stopped in three patients because of abdominal discomfort and distension. The change in intra abdominal pressure and haematocrit after 48 hours of hydration was comparable in both groups. New onset organ failure developed in 17.1% (6 of 35) of patients in the NJ group compared with 35.1% (20 of 57)of in the IV group (P＜0.05). The persistent organ failure developed in 34.3% (12 of 35) of patients in the NJ group compared with 50.9% (29 of 57) of in the IV group (P＜0.05). Conclusion: NJ fluid resuscitation is feasible, safe and effective in a select group of patients with predicted SAP.