Chang Arunchai, Pausawasdi Nonthalee, Charatcharoenwitthaya Phunchai, Kaosombatwattana Uayporn, Sriprayoon Tassanee, Limsrivilai Julajak, Prachayakul Varayu, Leelakusolvong Somchai
Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Gastroenterology, Department of Medicine, Hatyai Hospital, Songkla, Thailand.
Dig Dis Sci. 2022 Aug;67(8):4122-4130. doi: 10.1007/s10620-021-07256-z. Epub 2021 Oct 15.
Aggressive intravenous fluid hydration, by administering 3500 mL of lactated Ringer's solution (LRS) in 9 h with a peri-procedural bolus, reduces post-ERCP pancreatitis (PEP) incidence. A concern of this strategy is adverse events related to volume overload; however, the impact of fluid hydration over an extended period without a bolus on PEP is unknown.
To assess the effect of continuous infusion of high-volume fluid at a constant rate over 24 h on PEP incidence and severity.
Two-hundred patients were randomly assigned (1:1) to receive either 3600 mL of LRS in 24 h starting 2 h before the ERCP (high-volume group) or maintenance fluid hydration calculated by the Holliday-Segar method (control group).
The mean age of the patients was 50.6 ± 11.6 years. The predominant indications were choledocholithiasis (48%) and malignancies (32%). Patient demographics and PEP risk factors were similar in both groups. Patients in the high-volume group received significantly more fluid than the control group (3600 vs. 2413 ml, P < 0.001). PEP incidence was not different between the high-volume and the control group (14% vs. 15%; relative risk 0.93: 95% CI 0.48-1.83, P = 0.84). There were no differences in moderate to severe PEP (3% vs. 4%; relative risk 0.75: 95% CI, 0.17-3.27, P = 1.00). Subgroup analysis did not show a benefit in high-risk patients. Only one patient in the control group developed peripheral edema.
An infusion of high-volume hydration over 24 h is not sufficient to provide optimal hydration for PEP prevention.
No. NCT02821546.
积极的静脉补液，即在9小时内给予3500毫升乳酸林格氏液（LRS）并在围手术期推注，可降低内镜逆行胰胆管造影术后胰腺炎（PEP）的发生率。该策略的一个担忧是与容量超负荷相关的不良事件；然而，长时间无推注补液对PEP的影响尚不清楚。
评估24小时持续恒速输注大量液体对PEP发生率和严重程度的影响。
200例患者随机（1:1）分配，在ERCP前2小时开始的24小时内接受3600毫升LRS（大量补液组）或通过霍利迪-西加尔方法计算的维持性补液（对照组）。
患者的平均年龄为50.6±11.6岁。主要适应症为胆总管结石（48%）和恶性肿瘤（32%）。两组患者的人口统计学和PEP危险因素相似。大量补液组患者接受的液体量明显多于对照组（3600 vs. 2413毫升，P<0.001）。大量补液组和对照组的PEP发生率无差异（14% vs. 15%；相对风险0.93：95%CI 0.48-1.83，P=0.84）。中重度PEP无差异（3% vs. 4%；相对风险0.75：95%CI，0.17-3.27，P=1.00）。亚组分析未显示高危患者有获益。对照组仅1例患者出现外周水肿。
24小时输注大量液体不足以提供预防PEP的最佳补液。
NCT02821546。
