羟乙基淀粉及腹腔微创穿刺引流对重症急性胰腺炎早期腹内压及炎症因子的影响

发布时间：2019-06-12 03:40

【摘要】：目的： 研究羟乙基淀粉对重症急性胰腺炎(severe acute pancreatitis, SAP)合并腹腔高压Intra-abdominal hypertention, IAH)患者早期腹内压(Intra-abdominal pressure, IAP),炎症因子和肾功能的影响。方法： 回顾性分析2007年10月-2008年11月我中心SAP临床研究数据库,选取SAP合并IAH (IAP12mmHg)的患者作为研究对象。根据液体复苏方案将患者分为研究组(乳酸林格溶液联合羟乙基淀粉复苏)和对照组(仅用乳酸林格溶液复苏),分析两组间IAP,平均APACHE Ⅱ评分,炎症因子(IL-1, IL-8和TNF-α),肾功能(BUN和Cr)差异。 结果： 共有55例患者进入研究,其中研究组患者24例,对照组31例。两组患者的基线水平一致。治疗后第3天和第5-8天,研究组和对照组的IAP水平差异有统计学意义(P0.05)；平均IAP相对基线的下降幅度自第3天起,研究组明显大于对照组(P0.05)；平均APACHE Ⅱ评分相对基线的下降幅度自第5天起,研究组明显大于对照组(P0.05); IL-1和IL-8水平于第8天研究组显著低于对照组(P0.05)；TNF-α水平于第4天和第8天研究组显著低于对照组(P0.05)。入院后第1,4,8天研究组和对照组BUN和Cr差异无统计学意义。结论： 使用羟乙基淀粉130/0.4氯化钠注射液有助于降低重症急性胰腺炎合并腹腔高压患者的腹内压和APACHE Ⅱ评分、下调炎症因子,对肾功能的影响差异无统计学意义。 目的： 探讨重症急性胰腺炎(severe acute pancreatitis, SAP)合并腹腔高压患者早期行腹腔穿刺置管引流的意义。方法： 回顾性分析2009年11月-2010年10月我院胰腺外科中心确诊的SAP患者的临床资料。穿刺组共17例患者,均于入院后1周内行腹腔微创穿刺引流；对照组共17例患者,从未行腹腔穿刺的患者中随机选出并与穿刺组患者严格配对。分析两组间腹腔压力,中心静脉压,心率,APACHE II评分,C-反应蛋白,TNF-α, IL-1, IL-6以及IL-8水平的差异。结果： 穿刺组于入院后0-6d(平均1d)内行腹腔微创穿刺引流,引流时间为2-8d(平均5d),引流量为2871±2210ml。穿刺组腹腔压力和中心静脉压于穿刺首日较对照组明显下降,穿刺第二日起下降速度慢于对照组；心率和APACHE II评分穿刺组下降快于对照组,差异无统计学意义；与对照组相比,穿刺组C-反应蛋白,TNF-α, IL-1,IL-6以及IL-8水平下降较快或增加较慢,差异有统计学意义。结论： 早期腹腔微创穿刺引流能降低SAP患者IAP,下调炎症因子水平,可能可改善合并有腹腔高压或腹腔室间隔综合征的患者预后。微创穿刺引流在SAP患者中的确切作用需要进一步的RCTs证实。 目的： 分析重症急性胰腺炎(severe acute pancreatitis, SAP)患者早期中心静脉压(central venous pressure, CVP)与腹腔压力intra-abdominal pressure, IAP)之间的关系。方法： 回顾性分析2007年10月-2008年11月我中心SAP临床研究数据库。所有患者均于发病后72小时内就诊,分析入院首日CVP随IAP变化的关系。运用EmpowerStates和R软件(http://www.R-project.org)进行统计学分析,p0.05为有统计学差异。根据CVP水平3分组,分析患者一般情况。以CVP为因变量,IAP为自变量绘制散点图并进行曲线拟合。运用阈值效应分析方法,构建CVP和IAP的拟合曲线并寻找曲线拐点,并构建CVP和LAP的一般线性回归模型和二分段线性回归模型。进而运用多元回归模型,分析连续变量IAP对连续变量CVP的独立作用的大小,得出IAP对CVP的回归系数和95%置信区间(95%CI)。结果： 在SAP入院首日,CVP随IAP的增加呈现出先上升后下降的趋势；将纳入人群按一般情况及病情严重程度分组后,不同亚组中CVP仍呈现出随IAP的增加而先增加后减小的趋势。通过阈值效应分析,发现当IAP15.7mmHg时,CVP随IAP的增加而增加(β:0.21,95%CI:[0.00,0.41], P=0.054);当IAP15.7mmHg时,CVP随IAP的增加而减小(p:2.12,95%CI:[-2.67,-1.57], P0.001).当校正了平均动脉压和腹腔灌注压后,相似的趋势同样存在。结论： 在早期SAP患者中,在IAP15.7mmHg时,CVP随IAP的增加在一定范围内波动,但总体呈现出上升的趋势；而当IAP大于15.7mmHg时,CVP随IAP的增加呈现出明显的下降趋势。
[Abstract]:Purpose: To study the effects of hydroxyethyl starch on intra-abdominal pressure (IAP), inflammatory factor and renal function in patients with severe acute pancreatitis (SAP) combined with intra-abdominal high-pressure intra-abdominal hypertonic (IAH) in response to that Method: Retrospective analysis of the SAP clinical study database from October 2007 to November 2008, and the patients with SAP combined with IAH (IAP12mmHg) were selected as the study. The subjects were to be investigated. The patients were divided into the study group (the lactic acid stand solution combined with the hydroxyethyl starch recovery) and the control group (resuscitation only with the lactate solution) according to the liquid resuscitation protocol, and the two groups of IAPs, the average APACHE II score, the inflammatory factor (IL-1, IL-8 and TNF-1), and the renal function (BUN and Cr) were analyzed. ) Difference Results: A total of 55 patients were enrolled in the study, of which 24 were in the study group In the control group,31 cases were in the control group. The two groups The level of IAP in the study group and the control group was statistically significant (P0.05), and the mean IAP level was significantly greater than that of the control group (P0.05), and the mean APACHE II score decreased relative to the baseline. The level of IL-1 and IL-8 in the study group was significantly lower than that in the control group (P0.05), and the level of TNF-1 was significantly lower than that of the control group (P0.05). (P0.05). The difference between BUN and Cr in the first, 4th, 8th day study group and control group after admission heterolionic system Conclusion: The use of hydroxyethyl starch 130/ 0.4 sodium chloride injection can help to reduce the intra-abdominal pressure and APACHE 鈪，

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