Division of Gastroenterology, University of Southern California, Los Angeles, California.
Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Healthcare System, West Haven, Connecticut.
Clin Gastroenterol Hepatol. 2014 Feb;12(2):303-7.e1. doi: 10.1016/j.cgh.2013.07.026. Epub 2013 Aug 3.
BACKGROUND & AIMS: Pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). We performed a pilot study to determine whether aggressive periprocedural hydration with lactated Ringer's solution reduces the incidence of pancreatitis after ERCP.
Patients who underwent first-time ERCP were randomly assigned to groups (2:1) that received aggressive hydration with lactated Ringer's solution (3 mL/kg/h during the procedure, a 20-mL/kg bolus after the procedure, and 3 mL/kg/h for 8 hours after the procedure, n = 39) or standard hydration with the same solution (1.5 mL/kg/h during and for 8 hours after procedure, n = 23). Serum levels of amylase, visual analogue pain scores (scale of 0-10), and volume overload were assessed at baseline and 2, 8, and 24 hours after ERCP. The primary end point, post-ERCP pancreatitis, was defined as hyperamylasemia (level of amylase >3 times the upper limit of normal) and increased epigastric pain (≥3 points on visual analogue scale) persisting for ≥24 hours after the procedure. Secondary end points included hyperamylasemia, increased pain, and volume overload.
None of the patients who received aggressive hydration developed post-ERCP pancreatitis, compared with 17% of patients who received standard hydration (P = .016). Hyperamylasemia developed in 23% of patients who received aggressive hydration vs 39% of those who received standard hydration (P = .116, nonsignificant); increased epigastric pain developed in 8% of patients who received aggressive hydration vs 22% of those who received standard hydration (P = .146, nonsignificant). No patients had evidence of volume overload.
On the basis of a pilot study, aggressive intravenous hydration with lactated Ringer's solution appears to reduce the development of post-ERCP pancreatitis and is not associated with volume overload. ClinicalTrials.gov, Number: NCT 01758549.
胰腺炎是内镜逆行胰胆管造影（ERCP）最常见的严重并发症。我们进行了一项初步研究，以确定在 ERCP 后使用乳酸林格氏液进行积极的围手术期水化治疗是否会降低胰腺炎的发生率。
首次接受 ERCP 的患者被随机分为两组（2:1），一组接受乳酸林格氏液的积极水化治疗（手术期间 3 毫升/公斤/小时，手术后 20 毫升/公斤推注，手术后 8 小时内 3 毫升/公斤/小时，n=39），另一组接受相同溶液的标准水化治疗（手术期间和手术后 8 小时内 1.5 毫升/公斤/小时，n=23）。在 ERCP 前、后 2、8 和 24 小时评估血清淀粉酶水平、视觉模拟疼痛评分（0-10 分）和容量超负荷。主要终点为 ERCP 后胰腺炎，定义为高淀粉酶血症（淀粉酶水平超过正常上限的 3 倍）和上腹痛持续增加（视觉模拟评分≥3 分）持续 24 小时以上。次要终点包括高淀粉酶血症、疼痛增加和容量超负荷。
与接受标准水化治疗的患者相比，接受积极水化治疗的患者无一例发生 ERCP 后胰腺炎（17% vs 0.016）。接受积极水化治疗的患者中发生高淀粉酶血症的比例为 23%，而接受标准水化治疗的患者为 39%（P=0.116，无显著性差异）；接受积极水化治疗的患者中上腹痛增加的比例为 8%，而接受标准水化治疗的患者为 22%（P=0.146，无显著性差异）。没有患者出现容量超负荷的证据。
基于一项初步研究，使用乳酸林格氏液进行积极的静脉水化治疗似乎可以降低 ERCP 后胰腺炎的发生，并且不会导致容量超负荷。ClinicalTrials.gov，注册号：NCT 01758549。
