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目的:探讨早期腹腔穿刺引流(APD)对SAP患者疗效和预后的影响。方法:收集2017年5月至2021年12月间上海市第一人民医院收治的107例合并大量腹水的SAP患者临床资料，根据患者入院3 d内是否行腹腔穿刺引流(APD)分为APD组(56例)和非APD组(51例)。APD组再根据穿刺时是否已发生腹腔间隔室综合征(ACS)分为ACS亚组(29例)与非ACS亚组(27例)。记录患者的一般临床资料、全身炎症反应综合征(SIRS)持续时间、ICU住院时间、入院后1~3 d腹腔内压及炎症指标(白细胞计数及C反应蛋白水平)变化趋势、感染并发症发生率、升阶梯治疗情况、出院或死亡情况等。结果:APD组与非APD组患者的腹腔内压分别为(18.6±5.6)、(13.7±4.2) mmHg(1 mmHg＝0.133 kPa)，APD组较非APD组更高，差异有统计学意义( P＝0.000)。与非APD组比较，APD组SIRS持续时间更短[3(2，4)d比4(3，6)d， P＝0.029]。入院后1~3 dAPD组腹腔内压分别为(18.6±5.6)、(16.4±4.7)、(13.5±3.9) mmHg，非APD组为(13.7±4.2)、(12.3±3.6)、(11.0±2.6) mmHg，与非APD组比较，APD组腹腔压力下降更快( P＝0.004)；APD组白细胞计数分别为(14.8±4.8)、(10.5±4.5)、(9.0±3.8)×10 9/L，非APD组分别为(14.2±5.4)、(12.3±7.3)、(11.7±5.3)×10 9/L，与非APD组比较，APD组白细胞计数下降速度更快( P＝0.006)；APD组C反应蛋白分别为(153.6±47.1)、(150.4±10.5)、(108.8±49.4)mg/L，非APD组分别为(174.8±31.1)、(191.6±29.4)、(186.8±45.5) mg/L，APD组C反应蛋白含量显著下降，而非APD组未见下降趋势，差异有统计学意义( P＝0.009)。两亚组比较，ACS亚组SIRS持续时间长于非ACS组[4(3，5)d比2(1，3)d， P＝0.000]。两组及两亚组患者的ICU住院时间、感染并发症发生率、治疗进阶率及病死率差异均无统计学意义。 结论:对合并腹腔积液的SAP患者，早期APD可减少SIRS持续时间，快速降低腹内压，改善炎症指标，但并不能显著改善患者的预后。

Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.