不同容量液体复苏对重症急性胰腺炎器官功能的影响及……的治疗效果
Effect of Different-Volume Fluid Resuscitation on Organ Functions in Severe Acute Pancreatitis and Therapeutic Effect of .
作者信息
Yi Xiao-Lin, Hu Jing, Wu Qiu-Ting, Zhang Yu-Mei, Hu Qian, Yuan Ling, Miao Yi-Fan, Chen Huan, Zhu Lv, Li Juan, Zhao Xian-Lin, Yao Jia-Qi, Dai Xiao-Yu, Wan Mei-Hua, Tang Wen-Fu
机构信息
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Gastroenterology, Leshan Municipal Hospital of Traditional Chinese Medicine, Leshan 614000, China.
出版信息
Evid Based Complement Alternat Med. 2020 Oct 14;2020:6408202. doi: 10.1155/2020/6408202. eCollection 2020.
OBJECTIVE
To explore the effect of different-volume fluid resuscitation (FR) on organ functions in severe acute pancreatitis (SAP) and to elucidate the therapeutic effect and mechanism of on organ injuries caused by high-volume FR.
METHODS
- Clinical study: retrospective analysis of thirty-one patients about the effect of titrated fluid resuscitation protocol (TFR) on the occurrence of acute kidney injury (AKI) secondary to SAP. 2. Experimental study: rats ( = 30) were randomly divided into five groups: sham, model, low-volume FR (1.5 ml/kg/h), high-volume FR (10 ml/kg/h), and combined with high-volume FR (10 ml/kg/h + intraintestinal administration 5 g/kg); serum or plasma indicators and histopathologic scores were compared to explore the effect and mechanism of different fluid volumes and on organ function in SAP.
RESULTS
The occurrence of AKI, fluid volume, and fluid velocity in TFR group was lower than that in the control group. Logistic regression analysis showed that increased Marshall scores and fluid velocity were risk factors for predicting occurrence of AKI in SAP. Low-volume FR decreased the levels of blood urea nitrogen (BUN), serum creatinine (Cr), matrix metalloproteinase (MMP), and pathologic scores of the pancreas and kidney. High-volume FR increased ascites, MMPs, and kidney pathologic scores. decreased the levels of BUN, Cr, MMPs, and pathologic scores of the pancreas and kidney and increased the arterial oxygen saturation.
CONCLUSION
TFR-associated lower fluid volume and velocity reduced the occurrence of AKI secondary to SAP. High volume might aggravate AKI via increased MMP release leading to endothelial glycocalyx damage and vascular endothelial dysfunction. reduced MMP release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. Therefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP.
目的
探讨不同容量液体复苏（FR）对重症急性胰腺炎（SAP）器官功能的影响，阐明大容量FR对器官损伤的治疗作用及机制。
方法
- 临床研究：回顾性分析31例患者，探讨滴定式液体复苏方案（TFR）对SAP继发急性肾损伤（AKI）发生情况的影响。2. 实验研究：将30只大鼠随机分为五组：假手术组、模型组、小容量FR组（1.5 ml/kg/h）、大容量FR组（10 ml/kg/h）以及联合大容量FR组（10 ml/kg/h + 肠道内给予5 g/kg）；比较血清或血浆指标及组织病理学评分，以探讨不同液体容量及对SAP器官功能的影响及机制。
结果
TFR组AKI的发生率、液体量及液体速度均低于对照组。Logistic回归分析显示，Marshall评分增加和液体速度加快是预测SAP患者发生AKI的危险因素。小容量FR降低了血尿素氮（BUN）、血清肌酐（Cr）、基质金属蛋白酶（MMP）水平以及胰腺和肾脏的病理评分。大容量FR增加了腹水、MMPs水平以及肾脏病理评分。降低了BUN、Cr、MMPs水平以及胰腺和肾脏的病理评分，并提高了动脉血氧饱和度。
结论
与TFR相关的较低液体容量和速度降低了SAP继发AKI的发生率。大容量可能通过增加MMP释放导致内皮糖萼损伤和血管内皮功能障碍，从而加重AKI。减少了MMP释放，减轻了糖萼损伤，并减轻了SAP中大容量液体加重的胰腺和肾脏损伤。因此，内皮糖萼保护可能是治疗SAP的一种新策略。
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