术后干预液体平衡在重症继发性腹膜炎患者中的应用效果
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摘要
目的探讨术后干预液体平衡在重症继发性腹膜炎患者中的应用效果。方法回顾性分析该院2013年7月至2015年12月收治的50例重症继发性腹膜炎患者的临床资料,按术后是否干预液体平衡分为研究组(干预液体平衡)和对照组(未干预液体平衡),比较两组患者液体负平衡时间、急性生理与慢性健康评分(APACHEⅡ评分)改善情况及并发症发生情况。结果研究组在术后平均(3.68±0.87)d时达到液体负平衡,对照组平均(4.81±1.14)d时达到液体负平衡,两组患者达到液体负平衡时间比较差异有统计学意义(t=3.940,P<0.05)。研究组患者APACHEⅡ评分在术后3d时低于对照组,两组差异有统计学意义(P<0.05),其余时间APACHEⅡ评分两组间比较差异无统计学意义(P>0.05)。研究组脏器功能不全、腹腔和盆腔感染及切口感染发生率均低于对照组,但组间比较差异无统计学意义(P>0.05)。结论重症继发性腹膜炎患者术后干预液体平衡可快速达到液体负平衡,早期改善病情严重程度,对并发症的发生可能有一定改善作用。
Objective To investigate the application effect of postoperative fluid balance in the treatment with patients with severe secondary peritonitis.Methods A retrospective analysis was conducted on 50 cases of patients with severe secondary peritonitis in the hospital from July 2013 to December 2015,who were divided into the research group(intervention)and the control group(no intervention)by whether the invention of liquid balance was given,and liquid negative balance time,APACHE II score improvement,incidence of complications between two group were compared.Results The time of achieving fluid negative balance in the research group was(3.68±0.87)d,and was(4.81±1.14)d in the control group,and there was a statistically significant difference in the time of achieving fluid negative balance between the two groups(t=3.940,P<0.05).APACHE II score of the research group was lower than that of the control group at 3 dafter operation,and the difference was statistically significant(P<0.05).There was no significant difference between the two group at the rest of the time(P>0.05).The incidence rates of organ dysfunction,the abdominal cavity and pelvic cavity infection and incision infection of the research group were all lower than those of control group,but there was no significant difference between the two groups(P>0.05).Conclusion The invention of postoperative fluid balance for patients with severe secondary peritonitis could make it faster to achieve the liquid negative balance,and improve the severity of the disease at the early stage,and may reduce the occurrence of complications.
Objective To investigate the application effect of postoperative fluid balance in the treatment with patients with severe secondary peritonitis.Methods A retrospective analysis was conducted on 50 cases of patients with severe secondary peritonitis in the hospital from July 2013 to December 2015,who were divided into the research group(intervention)and the control group(no intervention)by whether the invention of liquid balance was given,and liquid negative balance time,APACHE II score improvement,incidence of complications between two group were compared.Results The time of achieving fluid negative balance in the research group was(3.68±0.87)d,and was(4.81±1.14)d in the control group,and there was a statistically significant difference in the time of achieving fluid negative balance between the two groups(t=3.940,P<0.05).APACHE II score of the research group was lower than that of the control group at 3 dafter operation,and the difference was statistically significant(P<0.05).There was no significant difference between the two group at the rest of the time(P>0.05).The incidence rates of organ dysfunction,the abdominal cavity and pelvic cavity infection and incision infection of the research group were all lower than those of control group,but there was no significant difference between the two groups(P>0.05).Conclusion The invention of postoperative fluid balance for patients with severe secondary peritonitis could make it faster to achieve the liquid negative balance,and improve the severity of the disease at the early stage,and may reduce the occurrence of complications.
引文
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[8]江山,车邦民,何绍明.不同复苏方法用于重度非控制性失血性休克犬早期复苏效果的比较[J].中华麻醉学杂志,2013,33(6):733-738.
[9]徐军,夏爱祥,王仲,等.小容量复苏对失血性休克犬血流动力学及内脏组织灌注的影响[J].中华创伤杂志,2009,25(2):112-115.
[10]刘霜,任晓旭,郭琳瑛,等.3%高渗盐水在儿童脓毒性休克早期液体复苏中的作用[J].中华儿科杂志,2015,53(8):599-604.
[2]闫东红,张观朝,刘松杰,等.继发性腹膜炎术后液体平衡干预的可行性[J].广州医学院学报,2013,41(5):42-45.
[3]Tolonen M,Sallinen V,Mentula P,et al.Preoperative prognostic factors for severe diffuse secondary peritonitis:a retrospective study[J].Langenbecks Arch Surg,2016,401(5):611-617.
[4]赵相旺,崔宇慧,唐建国,等.液体复苏的新进展[J].医学信息,2014,12(3):494.
[5]蒋志伟.毛细血管渗漏综合征研究进展[J].西南国防医药,2013,23(3):344-346.
[6]汪龙,李雷,麦威,等.腹腔镜结直肠癌根治术后第三间隙效应的临床研究[J].广西医学,2015,37(10):1387-1390.
[7]傅建军,朱宏亮,陈帆,等.连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用[J].南昌大学学报(医学版),2014,54(2):48-52.
[8]江山,车邦民,何绍明.不同复苏方法用于重度非控制性失血性休克犬早期复苏效果的比较[J].中华麻醉学杂志,2013,33(6):733-738.
[9]徐军,夏爱祥,王仲,等.小容量复苏对失血性休克犬血流动力学及内脏组织灌注的影响[J].中华创伤杂志,2009,25(2):112-115.
[10]刘霜,任晓旭,郭琳瑛,等.3%高渗盐水在儿童脓毒性休克早期液体复苏中的作用[J].中华儿科杂志,2015,53(8):599-604.