Wu Landy M, Pendharkar Sayali A, Asrani Varsha M, Windsor John A, Petrov Maxim S
From the Department of Surgery, University of Auckland, Auckland, New Zealand.
Pancreas. 2017 Aug;46(7):858-866. doi: 10.1097/MPA.0000000000000864.
Analgesia and intravenous fluid resuscitation are cornerstones of initial patient management in acute pancreatitis (AP). The aim was to investigate the effect of intravenous fluids and analgesia on gastrointestinal motility in the early course of AP.
Gastrointestinal dysmotility was assessed using the Gastroparesis Cardinal Symptom Index (GCSI). One-way analysis of variance and analysis of covariance were conducted, adjusting for age, sex, body mass index, severity of AP, preexisting diabetes mellitus, and time from first symptom onset to hospital admission.
A total of 108 patients with AP were prospectively enrolled. Opioid analgesia, when compared with nonopioid analgesia, was significantly associated with increase in total GCSI score in both unadjusted and adjusted analyses. There was no significant difference between aggressive and nonaggressive fluid resuscitation in both unadjusted and adjusted analyses. A combination of opioids and any intravenous fluids was associated with a significantly increased total GCSI score compared with opioids and no intravenous fluids in both unadjusted and adjusted analyses. Duration of symptoms was the confounder that significantly affected 6 of 9 studied associations.
Intravenous fluids and analgesia significantly affect motility independent of severity and other covariates. Guidelines on prudent use of opioids and fluids in AP need to be developed, particularly taking into account duration of symptoms from onset to hospitalization.
镇痛和静脉液体复苏是急性胰腺炎（AP）患者初始治疗的基石。本研究旨在探讨静脉输液和镇痛对AP早期胃肠动力的影响。
采用胃轻瘫主要症状指数（GCSI）评估胃肠动力障碍。进行单因素方差分析和协方差分析，并对年龄、性别、体重指数、AP严重程度、既往糖尿病史以及从首次出现症状到入院的时间进行校正。
共前瞻性纳入108例AP患者。在未校正和校正分析中，与非阿片类镇痛相比，阿片类镇痛均与总GCSI评分增加显著相关。在未校正和校正分析中，积极和非积极液体复苏之间均无显著差异。在未校正和校正分析中，与阿片类药物且无静脉输液相比，阿片类药物与任何静脉输液联合使用均与总GCSI评分显著增加相关。症状持续时间是显著影响9个研究关联中6个的混杂因素。
静脉输液和镇痛显著影响胃肠动力，且不受严重程度和其他协变量的影响。需要制定关于在AP中谨慎使用阿片类药物和液体的指南，尤其要考虑从发病到住院的症状持续时间。
