【摘要】：目的： 研究羥乙基淀粉對(duì)重癥急性胰腺炎(severe acute pancreatitis, SAP)合并腹腔高壓Intra-abdominal hypertention, IAH)患者早期腹內(nèi)壓(Intra-abdominal pressure, IAP),炎癥因子和腎功能的影響。方法： 回顧性分析2007年10月-2008年11月我中心SAP臨床研究數(shù)據(jù)庫(kù),選取SAP合并IAH (IAP12mmHg)的患者作為研究對(duì)象。根據(jù)液體復(fù)蘇方案將患者分為研究組(乳酸林格溶液聯(lián)合羥乙基淀粉復(fù)蘇)和對(duì)照組(僅用乳酸林格溶液復(fù)蘇),分析兩組間IAP,平均APACHE Ⅱ評(píng)分,炎癥因子(IL-1, IL-8和TNF-α),腎功能(BUN和Cr)差異。 結(jié)果： 共有55例患者進(jìn)入研究,其中研究組患者24例,對(duì)照組31例。兩組患者的基線水平一致。治療后第3天和第5-8天,研究組和對(duì)照組的IAP水平差異有統(tǒng)計(jì)學(xué)意義(P0.05)；平均IAP相對(duì)基線的下降幅度自第3天起,研究組明顯大于對(duì)照組(P0.05)；平均APACHE Ⅱ評(píng)分相對(duì)基線的下降幅度自第5天起,研究組明顯大于對(duì)照組(P0.05); IL-1和IL-8水平于第8天研究組顯著低于對(duì)照組(P0.05)；TNF-α水平于第4天和第8天研究組顯著低于對(duì)照組(P0.05)。入院后第1,4,8天研究組和對(duì)照組BUN和Cr差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論： 使用羥乙基淀粉130/0.4氯化鈉注射液有助于降低重癥急性胰腺炎合并腹腔高壓患者的腹內(nèi)壓和APACHE Ⅱ評(píng)分、下調(diào)炎癥因子,對(duì)腎功能的影響差異無(wú)統(tǒng)計(jì)學(xué)意義。 目的： 探討重癥急性胰腺炎(severe acute pancreatitis, SAP)合并腹腔高壓患者早期行腹腔穿刺置管引流的意義。方法： 回顧性分析2009年11月-2010年10月我院胰腺外科中心確診的SAP患者的臨床資料。穿刺組共17例患者,均于入院后1周內(nèi)行腹腔微創(chuàng)穿刺引流；對(duì)照組共17例患者,從未行腹腔穿刺的患者中隨機(jī)選出并與穿刺組患者嚴(yán)格配對(duì)。分析兩組間腹腔壓力,中心靜脈壓,心率,APACHE II評(píng)分,C-反應(yīng)蛋白,TNF-α, IL-1, IL-6以及IL-8水平的差異。結(jié)果： 穿刺組于入院后0-6d(平均1d)內(nèi)行腹腔微創(chuàng)穿刺引流,引流時(shí)間為2-8d(平均5d),引流量為2871±2210ml。穿刺組腹腔壓力和中心靜脈壓于穿刺首日較對(duì)照組明顯下降,穿刺第二日起下降速度慢于對(duì)照組；心率和APACHE II評(píng)分穿刺組下降快于對(duì)照組,差異無(wú)統(tǒng)計(jì)學(xué)意義；與對(duì)照組相比,穿刺組C-反應(yīng)蛋白,TNF-α, IL-1,IL-6以及IL-8水平下降較快或增加較慢,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論： 早期腹腔微創(chuàng)穿刺引流能降低SAP患者IAP,下調(diào)炎癥因子水平,可能可改善合并有腹腔高壓或腹腔室間隔綜合征的患者預(yù)后。微創(chuàng)穿刺引流在SAP患者中的確切作用需要進(jìn)一步的RCTs證實(shí)。 目的： 分析重癥急性胰腺炎(severe acute pancreatitis, SAP)患者早期中心靜脈壓(central venous pressure, CVP)與腹腔壓力intra-abdominal pressure, IAP)之間的關(guān)系。方法： 回顧性分析2007年10月-2008年11月我中心SAP臨床研究數(shù)據(jù)庫(kù)。所有患者均于發(fā)病后72小時(shí)內(nèi)就診,分析入院首日CVP隨IAP變化的關(guān)系。運(yùn)用EmpowerStates和R軟件(http://www.R-project.org)進(jìn)行統(tǒng)計(jì)學(xué)分析,p0.05為有統(tǒng)計(jì)學(xué)差異。根據(jù)CVP水平3分組,分析患者一般情況。以CVP為因變量,IAP為自變量繪制散點(diǎn)圖并進(jìn)行曲線擬合。運(yùn)用閾值效應(yīng)分析方法,構(gòu)建CVP和IAP的擬合曲線并尋找曲線拐點(diǎn),并構(gòu)建CVP和LAP的一般線性回歸模型和二分段線性回歸模型。進(jìn)而運(yùn)用多元回歸模型,分析連續(xù)變量IAP對(duì)連續(xù)變量CVP的獨(dú)立作用的大小,得出IAP對(duì)CVP的回歸系數(shù)和95%置信區(qū)間(95%CI)。結(jié)果： 在SAP入院首日,CVP隨IAP的增加呈現(xiàn)出先上升后下降的趨勢(shì)；將納入人群按一般情況及病情嚴(yán)重程度分組后,不同亞組中CVP仍呈現(xiàn)出隨IAP的增加而先增加后減小的趨勢(shì)。通過(guò)閾值效應(yīng)分析,發(fā)現(xiàn)當(dāng)IAP15.7mmHg時(shí),CVP隨IAP的增加而增加(β:0.21,95%CI:[0.00,0.41], P=0.054);當(dāng)IAP15.7mmHg時(shí),CVP隨IAP的增加而減小(p:2.12,95%CI:[-2.67,-1.57], P0.001).當(dāng)校正了平均動(dòng)脈壓和腹腔灌注壓后,相似的趨勢(shì)同樣存在。結(jié)論： 在早期SAP患者中,在IAP15.7mmHg時(shí),CVP隨IAP的增加在一定范圍內(nèi)波動(dòng),但總體呈現(xiàn)出上升的趨勢(shì)；而當(dāng)IAP大于15.7mmHg時(shí),CVP隨IAP的增加呈現(xiàn)出明顯的下降趨勢(shì)。
[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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