Horibe Masayasu, Kayashima Astuto, Ohbe Hiroyuki, Bazerbachi Fateh, Mizukami Yosuke, Iwasaki Eisuke, Matsui Hiroki, Yasunaga Hideo, Kanai Takanori
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Intensive Care. 2024 Jul 15;12(1):27. doi: 10.1186/s40560-024-00738-y.
Fluid resuscitation is fundamental in acute pancreatitis (AP) treatment. However, the optimal choice between normal saline (NS) and Ringer's solution (RS), and its impact on mortality in critically ill patients, remains controversial. This retrospective cohort study, utilizing a national Japanese inpatient database, investigates this question.
Using the Japanese Diagnosis Procedure Combination database between July 2010 and March 2021, we identified adult patients hospitalized in intensive care units (ICU) or high-dependency care units (HDU) for AP who survived at least three days and received sufficient fluid resuscitation (≥ [10 ml/kg/hr1 h + 1 ml/kg/hr71 h] ml) within three days of admission including emergency room infusions. Patients were classified into groups based on the predominant fluid type received: the NS group (> 80% normal saline) and the RS group (> 80% Ringer's solution). Propensity score matching was employed to reduce potential confounding factors and facilitate a balanced comparison of in-hospital mortality between the two groups.
Our analysis included 8710 patients with AP. Of these, 657 (7.5%) received predominantly NS, and 8053 (92.5%) received predominantly RS. Propensity score matching yielded 578 well-balanced pairs for comparison. The NS group demonstrated significantly higher in-hospital mortality than the RS group (12.8% [474/578] vs. 8.5% [49/578]; risk difference, 4.3%; 95% confidence interval, 0.3% to 8.3%).
In patients admitted to ICU or HDU with AP receiving adequate fluid resuscitation, RS can be a preferred infusion treatment compared to NS.
液体复苏是急性胰腺炎（AP）治疗的基础。然而，生理盐水（NS）和林格氏液（RS）之间的最佳选择及其对危重症患者死亡率的影响仍存在争议。这项回顾性队列研究利用日本全国住院患者数据库对这一问题进行了调查。
利用2010年7月至2021年3月的日本诊断程序组合数据库，我们确定了入住重症监护病房（ICU）或高依赖护理病房（HDU）的成年AP患者，这些患者存活至少三天，并在入院三天内接受了充分的液体复苏（≥[10毫升/千克/小时×1小时+1毫升/千克/小时×71小时]毫升），包括急诊室输液。根据接受的主要液体类型将患者分为两组：NS组（>80%生理盐水）和RS组（>80%林格氏液）。采用倾向评分匹配法减少潜在的混杂因素，便于对两组的院内死亡率进行均衡比较。
我们的分析纳入了8710例AP患者。其中，657例（7.5%）主要接受NS，8053例（92.5%）主要接受RS。倾向评分匹配产生了578对平衡良好的配对用于比较。NS组院内死亡率显著高于RS组（12.8%[474/578]对8.5%[49/578]；风险差异，4.3%；95%置信区间，0.3%至8.3%）。
在入住ICU或HDU且接受充分液体复苏的AP患者中，与NS相比，RS可能是更优选的输液治疗。
