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72hAPACHEⅡ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)hvs(.7.99±1.66)h,P<0.01],72h补液总量显著减少[(10780±1856)mLvs.(13845±2477)mL,P<0.01],肠道功能恢复所需时间显著缩短[(4.00±1.74)dvs(.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)dvs.(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。
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 [△APACHE 1I score （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.
出处
《中国实用外科杂志》
CSCD
北大核心
2011年第12期1121-1123,共3页
Chinese Journal of Practical Surgery
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
severe acute pancreatitis
fluid resuscitation
hydroxyethyl starch
dexamethasone
furosemide
