West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China.
West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China; West China Biobanks and Department of Clinical Research Management, West China Hospital, Sichuan University, China.
Pancreatology. 2022 Nov;22(7):894-901. doi: 10.1016/j.pan.2022.07.001. Epub 2022 Jul 8.
The goals and approaches to fluid therapy vary through different stages of resuscitation. This pilot study was designed to test the safety and feasibility of a fluid therapy protocol for the second or optimisation stage of resuscitation in patients with predicted severe acute pancreatitis (SAP).
Spontaneously breathing patients with predicted SAP were admitted after initial resuscitation and studied over a 24-h period in a tertiary hospital ward. Objective clinical assessment (OCA; heart rate, mean arterial pressure, urine output, and haematocrit) was done at 0, 4, 8, 12, 18-20, and 24 h. All patients had mini-fluid challenge (MFC; 250 ml intravenous normal saline within 10 min) at 0 h and repeated at 4 and 8 h if OCA score ≥2. Patients who were fluid responsive (>10% change in stroke volume after MFC) received 5-10 ml/kg/h, otherwise 1-3 ml/kg/h until the next time point. Passive leg raising test (PLRT) was done at each time point and compared with OCA for assessing volume status and predicting fluid responsiveness.
This fluid therapy protocol based on OCA, MFC, and PLRT and designed for the second stage of resuscitation was safe and feasible in spontaneously breathing predicted SAP patients. The PLRT was superior to OCA (at 0 and 8 h) for predicting fluid responsiveness and guiding fluid therapy.
This pilot study found that a protocol for intravenous fluid therapy specifically for the second stage of resuscitation in patients with predicted SAP was safe, feasible, and warrants further investigation.
液体治疗的目标和方法在复苏的不同阶段有所不同。本初步研究旨在测试一种用于预测严重急性胰腺炎（SAP）患者复苏第二阶段或优化阶段的液体治疗方案的安全性和可行性。
在最初复苏后，预计患有 SAP 的自主呼吸患者入住三级医院病房，并在 24 小时内进行研究。在 0、4、8、12、18-20 和 24 小时进行客观临床评估（OCA；心率、平均动脉压、尿量和血细胞比容）。所有患者在 0 小时进行迷你液体挑战（MFC；10 分钟内静脉注射 250 毫升生理盐水），如果 OCA 评分≥2，则在 4 和 8 小时重复进行。如果对 MFC 的反应性（SV 变化>10%），则给予 5-10ml/kg/h，否则给予 1-3ml/kg/h，直到下一个时间点。在每个时间点进行被动抬腿试验（PLRT），并与 OCA 比较，以评估容量状态和预测液体反应性。
基于 OCA、MFC 和 PLRT 并为复苏第二阶段设计的这种液体治疗方案在自主呼吸预测 SAP 患者中是安全且可行的。PLRT 在预测液体反应性和指导液体治疗方面优于 OCA（在 0 和 8 小时）。
本初步研究发现，一种专门用于预测 SAP 患者复苏第二阶段的静脉液体治疗方案是安全、可行的，值得进一步研究。
