Ding Xiaowen, Chen Bo
From the Department of Critical Care Medicine.
Department of Gastroenterology, QiLu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
Pancreas. 2023 Feb 1;52(2):e89-e100. doi: 10.1097/MPA.0000000000002230.
Despite the need for active fluid therapy, fluid management of most acute pancreatitis (AP) cases is still supportive. The aim of this review is to compare the effect of aggressive versus nonaggressive intravenous (IV) fluid resuscitation in the treatment of acute pancreatitis.
A systematic search of medical databases, such as Medline, Google Scholar, Science Direct, Cochrane Central, was conducted for publication until April 2022. We included randomized controlled trials or cohort (prospective and retrospective) studies reporting the outcomes of AP in patients that were managed with aggressive and nonaggressive IV fluid resuscitation. The primary outcome of interest was in-hospital mortality.
Fourteen trials involving 3423 acute pancreatitis patients were included in the review. We did not observe any differences in the risk of mortality, persistent organ failure, and systemic inflammatory response syndrome in both study groups. However, there was an increased risk of development of pancreatic necrosis, renal failure, and respiratory failure in the aggressive fluid therapy group compared with nonaggressive therapy. The funnel plot showed no publication bias.
Aggressive fluid therapy did not improve mortality rates in acute AP patients and was associated with an increased risk of acute renal failure, and respiratory failure.
尽管急性胰腺炎（AP）患者需要积极的液体治疗，但大多数病例的液体管理仍为支持性治疗。本综述的目的是比较积极与非积极静脉（IV）液体复苏在急性胰腺炎治疗中的效果。
对医学数据库进行系统检索，如Medline、谷歌学术、科学Direct、考克兰中心，直至2022年4月发表的文献。我们纳入了随机对照试验或队列（前瞻性和回顾性）研究，这些研究报告了接受积极和非积极IV液体复苏治疗的急性胰腺炎患者的结局。感兴趣的主要结局是住院死亡率。
本综述纳入了14项涉及3423例急性胰腺炎患者的试验。我们未观察到两个研究组在死亡率、持续性器官衰竭和全身炎症反应综合征风险方面存在任何差异。然而，与非积极治疗相比，积极液体治疗组发生胰腺坏死、肾衰竭和呼吸衰竭的风险增加。漏斗图显示无发表偏倚。
积极液体治疗并未提高急性胰腺炎患者的死亡率，且与急性肾衰竭和呼吸衰竭风险增加相关。
