Wu Fei, She Dong, Ao Qin, Zhang Shan, Li Jin
Department of Emergency, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2022 Sep 8;9:966824. doi: 10.3389/fmed.2022.966824. eCollection 2022.
The aim of this meta-analysis was to determine the role of an aggressive intravenous hydration protocol of Lactated Ringer's solution in patients with mild acute pancreatitis (MAP).
A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI) to identify randomized controlled trials (RCTs) published before August 19, 2022. The clinical outcomes were evaluated using the standard mean difference (SMD), mean difference (MD), risk ratio (RR), and 95% confidence interval (CI). The primary outcome was clinical improvement, while the secondary outcomes were the development of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), relief of epigastric abdominal pain, and length of hospital stay (LoH). Statistical analysis was performed with RevMan 5.4. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group system was used to determine the quality of evidences.
There were five RCTs with 370 MAP patients included, and the overall methodological quality was moderate. Aggressive hydration protocol was comparable to standard hydration protocol in terms of clinical improvement (RR = 1.33, 95%CI = 0.95-1.87, = 0.10; very low evidence). Fewer events of SIRS (RR = 0.48, 95%CI = 0.31-0.72, < 0.001; low evidence) and MODS (RR = 0.34, 95%CI = 0.13-0.91, = 0.03; moderate evidence) were reported in patients receiving aggressive hydration protocol. Meanwhile, aggressive hydration protocol also significantly relieved epigastric abdominal pain (SMD = -0.53, 95%CI = -0.81 to -0.25, < 0.001; low evidence) and shorten the LoH (MD = -2.36, 95%CI = -3.17 to -1.55, < 0.001; low evidence) compared with standard hydration protocol.
For patients with MAP, aggressive hydration protocol may be more effective than standard hydration protocol at lowering SIRS and MODS rates, relieving epigastric abdominal pain, and shortening the LoH. Due to the small number of studies that are eligible and poor methodological quality of eligible studies, further studies are required to validate our findings.
本荟萃分析旨在确定乳酸林格氏液积极静脉补液方案在轻度急性胰腺炎（MAP）患者中的作用。
在PubMed、EMBASE、Cochrane图书馆和中国知网（CNKI）中进行系统检索，以识别2022年8月19日前发表的随机对照试验（RCT）。使用标准平均差（SMD）、平均差（MD）、风险比（RR）和95%置信区间（CI）评估临床结局。主要结局是临床改善，次要结局是全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）的发生、上腹部疼痛缓解情况以及住院时间（LoH）。使用RevMan 5.4进行统计分析。采用推荐分级、评估、制定与评价（GRADE）工作组系统来确定证据质量。
纳入了5项RCT，共370例MAP患者，总体方法学质量为中等。在临床改善方面，积极补液方案与标准补液方案相当（RR = 1.33，95%CI = 0.95 - 1.87，P = 0.10；证据质量极低）。接受积极补液方案的患者报告的SIRS事件（RR = 0.48，95%CI = 0.31 - 0.72，P < 0.001；证据质量低）和MODS事件（RR = 0.34，95%CI = 0.13 - 0.91，P = 0.03；证据质量中等）较少。同时，与标准补液方案相比，积极补液方案还能显著缓解上腹部疼痛（SMD = -0.53，95%CI = -0.81至 -0.25，P < 0.001；证据质量低）并缩短住院时间（MD = -2.36，95%CI = -3.17至 -1.55，P < 0.001；证据质量低）。
对于MAP患者，积极补液方案在降低SIRS和MODS发生率、缓解上腹部疼痛以及缩短住院时间方面可能比标准补液方案更有效。由于符合条件的研究数量较少且符合条件研究的方法学质量较差，需要进一步研究来验证我们的发现。
