Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Dig Dis Sci. 2024 Jan;69(1):262-274. doi: 10.1007/s10620-023-08187-7. Epub 2023 Nov 28.
Fluid resuscitation is one of the main therapies for acute pancreatitis (AP). There is still no consensus on the type of fluid resuscitation. This study investigated the differences between lactate Ringer's (LR) and normal saline (NS) in treating AP.
Two authors systematically searched Web of Science, Embase (via OVID), Cochrane Library, and PubMed to find all published research before July, 2023. The odds of moderately severe/severe AP and intensive care unit (ICU) admission are set as primary endpoints.
This meta-analysis included 5 RCTs and 4 observational studies with 1424 AP patients in LR (n = 651) and NS (n = 773) groups. The results suggested that the odds of moderately severe/severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001) and ICU admission (OR 0.37; 95%Cl 0.16 to 0.87; P = 0.02) were lower in the LR group compared to NS group. In addition, the LR group had lower rates of local complications (OR 0.54; 95%Cl 0.32 to 0.92; P = 0.02), lower level of CRP, as well as a shorter hospital stay (WMD, - 1.09 days; 95%Cl - 1.72 to - 0.47 days; P < 0.001) than the NS group. Other outcomes, such as mortality, the rate of organ failure, SIRS, acute fluid collection, pancreatic necrosis, pseudocysts, and volume overload, did not differ significantly between two groups (P > 0.05).
LR is preferred over NS as it decreases the odds of moderately severe/severe AP, the rate of ICU admission, local complication, and length of hospital stay. However, large-scale RCT are lacking to support these evidence.
液体复苏是治疗急性胰腺炎（AP）的主要治疗方法之一。对于液体复苏的类型仍没有达成共识。本研究旨在探讨乳酸林格氏液（LR）与生理盐水（NS）在治疗 AP 方面的差异。
两位作者系统地检索了 Web of Science、Embase（通过 OVID）、Cochrane 图书馆和 PubMed，以查找截至 2023 年 7 月发表的所有研究。将中度重症/重症 AP 和重症监护病房（ICU）入住的几率设为主要终点。
这项荟萃分析纳入了 5 项 RCT 和 4 项观察性研究，共纳入 1424 例 AP 患者，LR 组（n=651）和 NS 组（n=773）。结果表明，与 NS 组相比，LR 组中度重症/重症 AP（OR 0.48；95%Cl 0.34 至 0.67；P<0.001）和 ICU 入住（OR 0.37；95%Cl 0.16 至 0.87；P=0.02）的几率较低。此外，LR 组局部并发症发生率（OR 0.54；95%Cl 0.32 至 0.92；P=0.02）、CRP 水平较低、住院时间较短（WMD，-1.09 天；95%Cl-1.72 天至-0.47 天；P<0.001）均低于 NS 组。两组之间的其他结局，如死亡率、器官衰竭率、SIRS、急性液体积聚、胰腺坏死、假性囊肿和容量过载，差异无统计学意义（P>0.05）。
LR 优于 NS，因为它降低了中度重症/重症 AP、ICU 入住率、局部并发症和住院时间的几率。然而，缺乏大规模 RCT 来支持这些证据。
