临床护理路径的实施是否对急性胰腺炎的早期静脉补液治疗有影响？一项试点质量改进研究。

Does the Implementation of a Clinical Care Pathway Have an Impact on Early Intravenous Fluid Therapy of Acute Pancreatitis?: A Pilot Quality Improvement Study.

机构信息

From the Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter.

Department of Surgery, Norwich & Norfolk University Hospitals NHS Foundation Trust, Norwich, United Kingdom.

出版信息

Pancreas. 2021 Feb 1;50(2):189-195. doi: 10.1097/MPA.0000000000001736.

DOI:10.1097/MPA.0000000000001736

PMID:33565794

Abstract

OBJECTIVES

Early intravenous fluid (IVF) resuscitation is crucial in the management of acute pancreatitis; variation in IVF prescription practice had been demonstrated. This pilot study aims to assess whether the implementation of an Acute Pancreatitis Care Pathway (APCP) produces a change toward a more adequate IVF regimen in the first 24 hours.

METHODS

Patients with confirmed diagnosis of acute pancreatitis, from July 2015 to February 2016 (group 1) and from September 2017 to March 2018 (group 2), were considered. The APCP was developed between March 2016 and August 2017. Median IVF rate, volume, and type infused in the first 24 hours, were compared between groups. Nonparametric data were analyzed with the Mann-Whitney U test, differences in frequencies with the McNemar test; significance was set at P < 0.05.

RESULTS

Seventy-two patients were included, 36 in each group. In the first 24 hours, the median IVF rate was 177 mL/h vs 225 mL/h (P = 0.004); Ringer lactate infusion was 30% vs 77.8% (P = 0.0003). The median total IVF volume did not differ between groups.

CONCLUSIONS

The implementation of the APCP has the potential to lead to a successful change in early IVF resuscitation practice.

摘要

目的

急性胰腺炎的治疗中，早期静脉补液（IVF）复苏至关重要；先前已经证实 IVF 处方实践存在差异。本初步研究旨在评估急性胰腺炎护理路径（APCP）的实施是否会使头 24 小时内更合理的 IVF 方案得到实施。

方法

2015 年 7 月至 2016 年 2 月（组 1）和 2017 年 9 月至 2018 年 3 月（组 2）期间确诊为急性胰腺炎的患者被纳入研究。APCP 于 2016 年 3 月至 2017 年 8 月之间开发。比较两组患者在头 24 小时内的 IVF 输注率、量和类型。非参数数据采用曼-惠特尼 U 检验进行分析，采用 McNemar 检验比较频率差异；P 值<0.05 为差异有统计学意义。