摘要
目的 评价液体复苏对重症急性胰腺炎（SAP）患者酸碱平衡及电解质的影响程度.方法 采用前瞻性自身对照研究方法 ,对入院的22例SAP急性期患者根据设定的液体复苏目标进行液体复苏,比较患者复苏前后血气分析、酸碱平衡及电解质的变化,并分析复苏液体总量与血Cl^-之间的相关性.结果 22例SAP患者平均复苏时间（15.0±2.4） h;复苏液体总量3 459～4 203 ml,平均（3 910±102） ml.液体复苏后血Na^＋（mmol/L）和血Cl^-（mmol/L）均较复苏前升高（Na^＋：145.83±1.85比139.67±2.25,Cl^-：117.33±1.64比101.83±1.77,均P〈0.05）,血pH值、血细胞比容（Hct）、阴离子隙（AG,mmol/L）、血乳酸（mmol/L）较复苏前下降（pH值：7.39±0.02比7.42±0.02,Hct：35.63±1.58比46.85±2.38,AG：8.02±1.21比14.47±0.89,血乳酸：1.10±0.18比1.97±0.15,P〈0.05或P〈0.01）;血Cl-与复苏液体总量之间存在正相关（r=0.720 8,P〈0.01）.结论 对SAP患者应制定适宜的液体复苏目标,控制晶体液输入总量,在液体复苏同时,应注意监测患者内环境的变化.
Objective To evaluate the effect of liquid resuscitation on acid-base balance and electrolytes of patients with severe acute pancreatitis （SAP）. Methods According to the target of liquid resuscitation, 22 patients with SAP involved in this self-controlled prospective study received sufficient liquid resuscitation in acute stage of acute pancreatitis. The results of blood gas analysis, acid-base balance and electrolytes were compared before and after liquid resuscitation. The correlation between the volume of liquid used in resuscitation and the level of blood chlorine was analyzed. Results The mean resuscitation duration was （15.0±2.4） hours, and the volume of liquid resuscitation was 3 459 4 203 ml, with mean volume （3 910±102） ml in 22 patients; blood sodium （mmol/L） and chlorine （mmol/L） levels were both significantly higher after resuscitation compared with those before resuscitation （Na^＋： 145.83±1.85 vs. 139.67±2.25, Cl^-： 117.33±1.64 vs. 101.83±1.77, both P〈0.05）. Blood pH value, hematocrit （Hct）, anion gap （AG, mmol/L）, blood lactic acid （mmol/L） were slightly lowered after resuscitation （pH value： 7.39±0.02 vs. 7.42±0.02, Hct： 35.63±1.58 vs. 46.85±2.38, AG： 8.02±1.21 vs. 14.47±0.89, blood lactic acid： 1.10±0.18 vs. 1.97±0.15, P〈0.05 or P〈0.01）. In addition, the level of blood chlorine was significantly correlated with the volume of liquid used in resuscitation （r=0.720 8, P〈0.01）. Conclusion The target of liquid resuscitation in patients with SAP should be cautiously determined, including control of the volume of liquid for resuscitation, in order to avoid acid-base imbalance or hyperchloraemia. At the same time, the change in internal environment should be monitored.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2010年第9期522-524,共3页
Chinese Critical Care Medicine
基金
全军医药卫生科研基金资助项目（06G041）
关键词
液体复苏
胰腺炎
急性
重症
内稳态
Liquid resuscitation
Severe acute pancreatitis
Homeostasis
