Emergency Medical Center, Fukuyama City Hospital, Zao-cho, Fukuyama City.
Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Kanno-cho, Kakogawa City, Hyogo.
J Clin Gastroenterol. 2019 May/Jun;53(5):385-391. doi: 10.1097/MCG.0000000000001046.
Although fluid resuscitation is critical in acute pancreatitis, the optimal fluid volume is unknown. The aim of this study is to evaluate the association between the volume of fluid administered and clinical outcomes in patients with severe acute pancreatitis (SAP).
We conducted a multicenter retrospective study at 44 institutions in Japan. Inclusion criteria were age 18 years or older, and diagnosed with SAP from 2009 to 2013. Patients were stratified into 2 groups: administered fluid volume <6000 and ≥6000 mL in the first 24 hours. We evaluated the association between the 2 groups and clinical outcomes using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of pancreatic infection and the need for surgical intervention.
We analyzed 1097 patients, and the mean fluid volume administered was 5618±3018 mL (mean±SD), with 708 and 389 patients stratified into the fluid <6000 mL and fluid ≥6000 mL groups, respectively. Overall in-hospital mortality was 12.3%. The fluid ≥6000 mL group had significantly higher mortality than the fluid <6000 mL group (univariable analysis, 15.9% vs. 10.3%; P<0.05). In multivariable logistic regression analysis, administration of ≥6000 mL of fluid within the first 24 hours was significantly associated with reduced mortality (odds ratio, 0.58; P<0.05). No significant association was found between the administered fluid volume and pancreatic infection, or between the volume administered and the need for surgical intervention.
In patients with SAP, administration of a large fluid volume within the first 24 hours is associated with decreased mortality.
尽管在急性胰腺炎中进行液体复苏至关重要，但最佳液体量尚不清楚。本研究旨在评估在重症急性胰腺炎（SAP）患者中给予的液体量与临床结局之间的关系。
我们在日本的 44 家机构进行了一项多中心回顾性研究。纳入标准为年龄≥18 岁，并且在 2009 年至 2013 年期间被诊断为 SAP。患者分为两组：在 24 小时内给予<6000 毫升和≥6000 毫升的液体。我们使用多变量逻辑回归分析评估两组之间与临床结局的关系。主要结局是住院死亡率。次要结局包括胰腺感染的发生率和手术干预的需要。
我们分析了 1097 名患者，给予的平均液体量为 5618±3018 毫升（均值±标准差），其中 708 名和 389 名患者分别分为液体<6000 毫升和液体≥6000 毫升组。总体住院死亡率为 12.3%。液体≥6000 毫升组的死亡率明显高于液体<6000 毫升组（单变量分析，15.9% vs. 10.3%；P<0.05）。多变量逻辑回归分析显示，在 24 小时内给予≥6000 毫升的液体与死亡率降低显著相关（比值比，0.58；P<0.05）。给予的液体量与胰腺感染之间，或给予的液体量与手术干预的需要之间没有显著关联。
在 SAP 患者中，在 24 小时内给予大量液体与死亡率降低相关。
