Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
World J Surg. 2013 Oct;37(10):2428-35. doi: 10.1007/s00268-013-2105-7.
Fluid therapy (FT) is a critical intervention in managing acute pancreatitis (AP). There is a paucity of evidence to guide FT and virtually no data on current prescribing practice. This survey aims to characterize current practice and opinion with regard to FT in AP throughout New Zealand.
Information was collected on fluid selection, administration, and goal-directed FT. The survey was distributed online and in print to all doctors employed in General Surgery Departments in New Zealand on 1 May 2012. Monthly email reminders were sent for 6 months.
The overall response rate was 47 % (n = 190/408). Crystalloids were the preferred initial fluid for all categories of severity; however, colloid use increased with severity (p < 0.001). Fluid volume also increased with severity (p = 0.001), with 74 % of respondents prescribing >4 L for AP with organ failure (OF). Clinicians treating 26-50 patients per year with AP were less likely to prescribe colloid for AP with OF (8 vs 43 %) (p = 0.001). Rate of fluid administration in AP with OF varied according to physicians' seniority (p = 0.004); consultants prescribed >4 L more than other groups (83 vs 68 %). Only 17 % of respondents reported the use of guidelines.
This survey reveals significant variation in prescription of FT for AP, and aggressive FT is commonly prescribed for AP with OF. There is little adherence to published guidelines or best available evidence.
液体疗法（FT）是治疗急性胰腺炎（AP）的关键干预措施。目前缺乏指导 FT 的证据，实际上也没有关于当前处方实践的数据。本调查旨在描述新西兰各地 AP 中 FT 的当前实践和意见。
收集了关于液体选择、管理和目标导向 FT 的信息。该调查于 2012 年 5 月 1 日通过在线和印刷形式分发给新西兰所有普外科医生。每月发送电子邮件提醒，持续 6 个月。
总回复率为 47%（n=190/408）。所有严重程度的患者均首选晶体液作为初始液体；然而，胶体的使用随着严重程度的增加而增加（p<0.001）。液体量也随着严重程度的增加而增加（p=0.001），74%的受访者为有器官衰竭（OF）的 AP 开处方>4 L。每年治疗 26-50 例 AP 的医生更不可能为有 OF 的 AP 开胶体（8%比 43%）（p=0.001）。根据医生的资历，有 OF 的 AP 中的液体给药速度有所不同（p=0.004）；顾问比其他组多开>4 L（83 比 68%）。只有 17%的受访者报告使用了指南。
本调查显示，AP 的 FT 处方存在显著差异，并且对于有 OF 的 AP 通常会开出积极的 FT。几乎没有遵守已发布的指南或最佳可用证据。
