无创心排量联合中心静脉血氧饱和度监测对高脂血症性 重症胰腺炎早期目标导向性液体复苏的指导作用.

To investigate the guiding effect of noninvasive monitoring of cardiac output (CO) and central venous oxygen saturation (ScvO2) on early goal - directed fluid resuscitation in patients with hyperlipidemic severe acute pancreatitis. Methods A total of 84 patients with hyperlipidemic severe acute pancreatitis who were admitted to the People's Hospital of Huadu District from January 2018 to December 2020 were enrolled as subjects and randomly divided into research group and control group, with 42 patients in each group. In the control group, goal - directed fluid resuscitation was performed by monitoring mean arterial pressure and central venous pressure, and in the research group, goal - directed fluid resuscitation was guided by the dynamic monitoring of CO through a bedside Doppler noninvasive hemodynamic detector and the monitoring of ScvO2 through PreSep central venous catheter. The two groups were compared in terms of time to early volume reaching standard ( hour), time to relief of abdominal pain (day), time to gastrointestinal function recovery (day), time to triglyceride (TG) recovery (day), lactate clearance rate at 6 hours after treatment, change of Acute Physiology and Chronic Health Evaluation II (APACHE - II) score from before treatment to days 3 and 7 after treatment, and early complications of acute pancreatitis. The t - test was used for comparison of continuous data between groups, and the chi - square test was used for comparison of categorical data between groups. Results Compared with the control group, the research group had significantly shorter time to volume reaching standard (8.7 ± 1.6 hours vs 19.6 ±2.1 hours, t = -18.86, P <0.05), time to relief of abdominal pain (3.4 ± 1.2 days vs 5.8 ± 1.5 days, t = -16.74, P < 0.05), time to gastrointestinal function recovery (5.6 ± 2.3 days vs 8.2 ± 2.5 days, t = - 11.74, P < 0.05), and time for TG to decrease to the normal level (5.5 ± 1.6 days vs 9.7 ± 1.7 days, t = 10.76, P < 0.05). Compared with the control group, the research group had a significantly lower APACHE - II score on days 3 and 7 (day 3: 11.86 ± 1.88 vs 20.75 ± 1.63, t = - 17.36, P < 0.05; day 7: 6.21 ± 1.13 vs 14. 36 ± 1.53, t = - 18. 41, P < 0.05), a significantly lower arterial blood lactate level at 6 hours after admission (4. 24 ± 0.23 mmol/L vs 5.07 ± 0.17 mmol/L, t = - 17.76, P < 0.05 ), and a significantly higher arterial blood lactate clearance rate at 6 hours (23.74% ± 0. 44% vs 10.74% ± 0.67%, t = - 17.73, P < 0.05). The comparison of early complications showed that compared with the control group, the research group had significantly lower incidence rates of peripancreatic acute necrotic collection ( 4.76 % vs 19.05 %, x2 = 16.63, p <0. 05), pulmonary infection (9.52% vs 38.10%, χ² = 15.78, p < 0.05), pleural effusion (35.71 % vs 88.10%, χ² = 8.96, p < 0.05), gastrointestinal bleeding (7.14% vs 16.67%, χ² =7.45, p < 0.05), and organ failure ( 11. 90% vs 30.95%, χ² = 7.96, P < 0.05). Conclusion Noninvasive monitoring of CO and ScvO2 in clinical practice has an important guiding significance for early goal - directed fluid resuscitation in patients with hyperlipidemic severe acute pancreatitis and can significantly improve the clinical treatment outcome of hyperlipidemic severe acute pancreatitis. [ABSTRACT FROM AUTHOR]