Zhou Selena, Buitrago Carlos, Foong Andrew, Lee Vivian, Dawit Lillian, Hiramoto Brent, Chang Patrick, Schilperoort Hannah, Lee Alice, de-Madaria Enrique, Buxbaum James
Division of Gastroenterology, University of Southern California, USA.
Department of Library Science, University of Southern California, USA.
Pancreatology. 2021 Dec;21(8):1405-1410. doi: 10.1016/j.pan.2021.07.003. Epub 2021 Jul 26.
Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation.
In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables.
We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25-0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13-0.81) and local complications (OR 0.42; 95 % CI 0.2-0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant.
Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.
液体复苏是急性胰腺炎治疗的关键。尽管临床指南和专家意见在大量复苏方面达成了一致，但关于最佳液体类型仍存在争议。最常用的液体是乳酸林格氏液（LR）和生理盐水（NS），但迄今为止发表的比较LR与NS的研究结果相互矛盾。我们旨在识别并定量综合有关液体类型或急性胰腺炎复苏这一主题的现有高质量数据。
与研究团队合作，一名信息专家进行了全面的文献综述，以识别涉及液体复苏类型的报告。两名独立评审员使用Covidence系统对研究进行筛选，以识别比较LR与NS的随机对照试验。主要结局是中度重症或重症胰腺炎的发生，其他结局包括局部并发症、入住重症监护病房（ICU）和住院时间。使用随机效应模型估计合并比值比，并使用标准化均差比较连续变量。
我们检索了7964篇摘要和57篇全文文献。确定了四项随机对照试验并纳入我们的荟萃分析。共有122例患者接受LR复苏，126例接受NS复苏。接受LR复苏的患者发生中度重症/重症胰腺炎的可能性较小（比值比0.49；95%可信区间0.25 - 0.97）。两组在24小时或48小时时全身炎症反应综合征（SIRS）的发生或器官衰竭的发生方面没有差异。接受LR复苏的患者入住ICU的可能性较小（比值比0.33；95%可信区间0.13 - 0.81），发生局部并发症的可能性也较小（比值比0.42；95%可信区间0.2 - 0.88）。虽然接受LR复苏的患者住院时间有缩短的趋势（标准化均差 -0.18，99%可信区间 -0.44 - 0.07），但差异无统计学意义。
与NS相比，LR复苏可降低中度重症 - 重症胰腺炎的发生率。然而，SIRS发生或器官衰竭方面无差异，这突出表明需要进一步研究以验证这一发现并确定其机制。
