关键词: 急性胰腺炎, 液体治疗, 器官功能不全

Abstract: Objective Appropriate and timely initial fluid resuscitation in severe acute pancreatitis (SAP) is critical. The aim of this retrospective study was to evaluate the effects of difference between fluid therapy on an early goal-directed approach to resuscitation basis and the standard fluid therapy of adequate resuscitation on the prognosis of SAP. Methods The clinical data of SAP patients admitted to surgical intensive care unit within 72 hours after onset of symptoms between January 2000 and January 2010 were analyzed retrospectively. A total of eighty patients with a confirmed diagnosis of SAP were divided into two groups based on whether adopting the early goal-directed fluid resuscitation strategies or not. Patients admitted between January 2000 and December 2004 did not adopt the early goal-directed fluid resuscitation strategies, therefore, were allocated into standard fluid therapy group (n=34); the other patients admitted between January 2005 and January 2010 adopted the early goal-directed fluid resuscitation strategies and were allocated into early goal-directed fluid therapy group (n=46). With the exception of the fluid therapy strategies, the patients in the two groups received standard treatment for SAP. The acute physiology and chronic health evaluation Ⅱ score (APACHEⅡ) and multiple organ dysfunction score (Marshall), rate of multiple organ dysfunction syndrome (MODS) within the first week of hospital admission, pancreatic infection, and in-hospital mortality were compared between the two groups. Results Compared with the standard fluid therapy group on day 3 after admission, APACHEⅡ score and Marshall score decreased significantly in the early goal-directed fluid therapy group (APACHEⅡ score: 8.22±3.89 versus 11.35±4.27, P=0.017; Marshall score: 4.48±2.21 versus 6.82±3.15, P=0.021, respectively). In addition, patients in the early goal-directed fluid therapy group experienced a trend toward lower rate of MODS within the first week of hospital admission, pancreatic infection and in-hospital mortality (rate of MODS: 52% versus 62%,P=0.393;rate of pancreatic infection: 37% versus 44%,P=0.653;in-hospital mortality: 17% versus 24%,P=0.576, respectively) that did not reach statistical significance.ConclusionAlthough early goal-directed fluid therapy for SAP in acute response stage may have ameliorated the patient’s condition and improved outcome to a certain degree, carefully designed clinical trials should be performed in a randomized controlled manner to assess the role of such fluid resuscitation in SAP.

Key words: acute pancreatitis, fluid resuscitation, organ dysfunction