中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (12): 1121-1123.

• 论著 • 上一篇    下一篇

重症急性胰腺炎联合用药液体复苏疗效观察

张    健1a，杨正安1a，张正良1b，田    明2，贾红生3   

  1. 1西安交通大学医学院第二附属医院  a.干四（普通外科）病区 b.急诊科，陕西西安710004；2西安医学院附属医院普通外科，陕西西安710077；3西安电力中心医院普通外科，陕西西安710032
  • 出版日期:2011-12-01 发布日期:2011-11-28

  • Online:2011-12-01 Published:2011-11-28

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摘要：

目的    观察6%羟乙基淀粉130/0.4氯化钠注射液、地塞米松、速尿联合应用（VDF疗法）在重症急性胰腺炎（SAP）液体复苏中的作用和治疗效果。 方法    2006年1月至2010年5月间选择符合入选标准的SAP病人47例，随机分为VDF组（26例）和对照组（21例），VDF组给予VDF疗法，对照组输注乳酸林格液，其他治疗措施二组相同。 结果    VDF组病人较对照组72h APACHEⅡ评分显著降低［（4.28±1.90） vs. （-1.00±2.87），P<0.01］，达到血流动力学稳定时间显著缩短［（4.54±1.62）h vs.（7.99±1.66）h，P <0.01］， 72h补液总量显著减少［（10780±1856）mL vs. （13845±2477）mL，P <0.01］，肠道功能恢复所需时间显著缩短［(4.00±1.74)d vs.（5.26±1.92）d，P <0.05］，腹腔室隔综合征的发生率显著降低（3.8% vs. 28.6%，P <0.05），住院时间显著缩短［（20.12±10.37）d vs. （29.4±15.6）d，P <0.05］，病死率显著降低（3.8% vs. 23.8%，P <0.05）。在并发症发生率和中转手术率方面二者差异无统计学意义（P均>0.05）。 结论    VDF疗法可迅速而有效地控制SAP病情，改善预后，降低病死率。

关键词: 重症急性胰腺炎, 液体复苏, 羟乙基淀粉, 地塞米松, 呋塞米

Abstract:

Fluid resuscitation of severe acute pancreatitis with combining drug therapy        ZHANG Jian*, YANG Zheng-an, ZHANG Zheng-liang, et al.*Department of Cadres Ward-IV(General Surgery), the Second Affiliated Hospital of Medical School of Xi’an Jiaotong University, Xi’an 710004, China
Corresponding author: ZHANG Jian，E-mail: zhangjian-937@163.com
Abstract    Objective    To observe and evaluate the effect of VDF therapy (combining use of 6% hydroxyethyl starch 130 /0.4, Dexamethasone and Furosemide) on the severe acute pancreatitis (SAP) during fluid resuscitation stage. Methods    During January 2006 and May 2010, 47 consecutive cases of SAP were admitted. They were randomly assigned to VDF therapy group (26 cases) and control group(21 cases). Patients in VDF therapy group were administered with Voluven, Dexamethasone and Furosemide, while Ringer’s lactate was applied to the control group. Otherwise, the two group had the same therapeutic strategies.  Results VDF group remarkably improved the systemic inflammatory response after 72h admission, as compared with the control group ［△APACHEⅡscore (4.28±1.90) vs. (-1.00±2.87), P <0.01］. It had shorter time interval to reach the stable hemadynamic state ［（4.54±1.62）h vs. (7.99±1.66)h, P <0.01］ and total amount of fluid replacement within 72h after admission ［（10780±1856）mL vs. (13845±2477)mL, P <0.01］ than control group. The intestinal function recovered faster in VDF group than in control group ［(4.00±1.74)d vs. (5.26±1.92)d, P <0.05］. Compared with control group, VDF therapy significantly decreased the ACS （3.8% vs.28.6%, P <0.05）, time of hospital stay ［（20.12±10.37）d vs. (29.4±15.6)d, P <0.05］and mortality（3.8% vs. 23.8%, P <0.05）. Although there were no statistical differences in complications and transfer to operation in the two group（P >0.05）. Conclusion    Combined use of 6% hydroxyethyl starch 130 /0.4 (Voluven), Dexamethasone and Furosemide could improve the severity and prognosis of SAP fast and effectively and decrease the mortality of SAP significantly.

Key words: severe acute pancreatitis, fluid resuscitation, hydroxyethyl starch, dexamethasone, furosemide