赵晓琳,杨友鹏,张佳莹,李珍,蔡勇,程建平,曹世长,于久飞.PICCO指导重症急性胰腺炎早期液体复苏的效果评价[J].内科急危重症杂志,2016,22(4):
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| 中文关键词: PiCCO 重症急性胰腺炎 液体复苏 预后 |
| 英文关键词:PiCCO severe acute pancreatitis fluid resuscitation prognosis |
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| 中文摘要: |
| 目的 探讨脉搏连续心排血量（PICCO）指导早期液体复苏对重症急性胰腺炎（SAP）的临床意义。方法 选择我院消化科自2013年1月～2015年1月收治并应用PICCO指导早期液体复苏的37例SAP患 者作为PICCO组，同期选择应用中心静脉压（CVP）指导液体复苏的39例SAP患者作为对照组，比较两组48h内液体出入量、血管活性药物使用时间，以及机械通气时间、ICU住院时间和28天病死率。并应用受试者工作特征性（ROC）曲线分析28天病死率的危险因素。结果 共有76例患者入选，其中男41例，年龄58.76±13.84岁。两组间年龄、性别比例、入院血糖、血乳酸、血肌酐、氧和指数、平均动脉压、APACHE II 评分均无显著差异（P>0.05）。PiCCO组患者的0～6h补液量明显多于对照组（P<0.05），而6～72h补液量较对照组明显减少（P＜0.05）。PICCO组患者的血液净化率、机械通气时间、ICU住院时间均显著减少（P<0.05），但是两组患者应用血管活性药物的比例、导管相关感染率和28天病死率均无显著差别（P>0.05）。ROC曲线发现年龄（AUC 0.71, 95% CI, 0.63～0.76，P=0.03）和APACHE II评分（AUC 0.78, 95% CI, 0.67～0.91，P=0.02）为预测28天病死率的重要因素。结论PiCCO可以精确指导SAP患者早期液体复苏，并减少机械通气时间和ICU住院时间。 |
| 英文摘要: |
| Objective To evaluate the effect of PiCCO-guided fluid resuscitation in patients with severe acute pancreatitis (SAP). Methods 37 SAP patients with PiCCO-guided fluid resuscitation in our hospital from January 2013 to January 2015 was involved in PiCCO group. 39 SAP patients with central venous pressure (CVP)-guided fluid resuscitation in our hospital was involved in control group. We compared the change of fluid resuscitation in 48h, duration of vasopressor, mechanical ventilation, ICU stay, and 28-day mortality. Furthermore, we used the receptor-operating characteristic (ROC) curves evaluate prognostic factors for 28-day mortality. Result 81 SAP patients were enrolled. There were 41 males. The mean age was 58.76±13.84 years old. Basic characteristics, such as age, male rate, blood glucose, lactate level, creatinine level, oxygen index, mean arterial blood pressure and APACHE II score were comparable between the two groups (P > 0.05). The fluid intake during the first 6 hours was significantly more than the control group (P < 0.05). However, within 0-72 hours, fluid intake volume was significantly less in the PiCCO group than that in the control group (P < 0.05). Furthermore, PiCCO-guided therapy was associated with significantly decreased rate of renal replacement therapy, duration of mechanical ventilation and days stayed in ICU (P < 0.05). However, the percentage of vasopressor usage, catheter-related infection and 28-day mortality were similar between the two groups (P > 0.05). ROC curves demonstrated that age (AUC 0.71, 95% CI, 0.63～0.76,P=0.03), and APACHE II scores (AUC 0.78, 95% CI, 0.67～0.91,P=0.02) were all prognostic factors for 28-day mortality. Conclusion: PiCCO could accurately guided fluid resuscitation in SAP patients, with less duration of mechanical ventilation and days stayed in ICU. |
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