急性胰腺炎液体复苏的反应和结局：一项前瞻性队列研究。
Response and outcome from fluid resuscitation in acute pancreatitis: a prospective cohort study.
机构信息
Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China; Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China.
出版信息
HPB (Oxford). 2018 Nov;20(11):1082-1091. doi: 10.1016/j.hpb.2018.05.018. Epub 2018 Aug 29.
BACKGROUND
Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS).
METHODS
Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6-8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes.
RESULTS
At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6-8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups.
CONCLUSIONS
The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6-8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required.
背景
静脉（IV）液体复苏仍然是急性胰腺炎（AP）早期治疗的基石，但仍有许多问题尚未得到解答，包括如何确定患者是否会从额外的液体中获益。本研究旨在探讨血清生物标志物在有全身炎症反应综合征（SIRS）的 AP 患者中对 IV 液体复苏反应性的预测价值。
方法
符合条件的成年患者腹痛时间<36 h 且有≥2 个 SIRS 标准。平均动脉压（>65 mmHg）和尿量（>0.5 ml/kg/h）用于评估 IV 液体开始后 2 和 6-8 h 的反应性。在液体量、生物标志物和结局方面，比较反应性和无反应性患者的时间点。
结果
在 2 h 时，19 例患者对液体有反应（组 1），4 例患者无反应（组 2）；在 6-8 h 时，14 例患者有反应（组 3），9 例患者无反应（组 4）。患者组之间无人口统计学差异，但组 4 的预后特征较组 3 差。无反应组患者在最初 24 h 内接受的液体量明显更多（组 4 平均 7082 ml 比组 3 5022 ml，P < 0.001），且结局更差。两组间生物标志物无显著差异。
结论
血清生物标志物不能区分有反应性和无反应性患者。在 6-8 h 时无反应的患者入院时疾病更严重，不能从额外的液体中获益，且结局更差。需要新的方法来指导 AP 患者的液体复苏。
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