Tatsumi Hiroomi, Akatsuka Masayuki, Kuroda Hiromitsu, Kazuma Satoshi, Masuda Yoshiki
Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JPN.
Cureus. 2024 Jun 25;16(6):e63103. doi: 10.7759/cureus.63103. eCollection 2024 Jun.
Since severe acute pancreatitis (SAP) involves inflammatory mediators produced by local inflammation of the pancreas that trigger a systemic inflammatory response, intensive fluid management is required to maintain hemodynamics in the early stages of the onset of SAP. Goreisan is considered to have a diuretic effect in a state of excess water and an antidiuretic effect in a state of dehydration, regulating water balance in both directions. We investigated the clinical effects of Goreisan on water balance in SAP patients. Patients and methods SAP patients admitted to our ICU within 72 hours of being diagnosed with SAP were divided into two groups: the Rikkunshito group (before October 2015) and the Goreisan group (after November 2015). Cumulative volume of fluid infusion, urine, fluid removal by CHF, nasogastric tube drainage, and water balance from day 1 to day 5 of ICU admission.
Thirty patients were included. The median age was 57 (40-69) years, and 21/30 (70%) were male. The prognostic factor score in Japanese criteria for acute pancreatitis was 5.5 (3.3-7). Of the thirty patients, 14 were in the Rikkunshito group, and 16 were in the Goreisan group. There were no differences in the cumulative volume of fluid infusion, urine, fluid removal by CHF, or nasogastric tube drainage from day 1 to day 5 of ICU admission between the two groups. However, the cumulative water balance from day 1 to day 5 of admission was 4,957 ± 6,091 mL in the Rikkunshito group, whereas it was lower in the Goreisan group at 498 ± 3,918 mL (P = 0.023).
Our study showed that Goreisan administration in patients with severe acute pancreatitis might improve water balance in the early phase of onset. Early administration of Goreisan at the onset of severe acute pancreatitis may regulate fluid movement between capillaries and interstitium and alleviate fluid overload due to water refill.
由于重症急性胰腺炎（SAP）涉及胰腺局部炎症产生的炎症介质引发全身炎症反应，因此在SAP发病早期需要进行强化液体管理以维持血流动力学。 柴朴汤在水过多状态下被认为具有利尿作用，在脱水状态下具有抗利尿作用，可双向调节水平衡。我们研究了柴朴汤对SAP患者水平衡的临床效果。患者与方法：在确诊为SAP后72小时内入住我院ICU的SAP患者分为两组：六君子汤组（2015年10月之前）和柴朴汤组（2015年11月之后）。记录入住ICU第1天至第5天的累计输液量、尿量、连续性血液滤过脱水量、鼻胃管引流量及水平衡情况。
共纳入30例患者。 中位年龄为57（40 - 69）岁，21/30（70%）为男性。 日本急性胰腺炎标准中的预后因素评分为5.5（3.3 - 7）。30例患者中，14例在六君子汤组，16例在柴朴汤组。两组在入住ICU第1天至第5天的累计输液量、尿量、连续性血液滤过脱水量或鼻胃管引流量方面无差异。然而，六君子汤组入院第1天至第5天的累计水平衡为4,957 ± 6,091 mL，而柴朴汤组较低，为498 ± 3,918 mL（P = 0.023）。
我们的研究表明，对重症急性胰腺炎患者给予柴朴汤可能会在发病早期改善水平衡。在重症急性胰腺炎发病时早期给予柴朴汤可能调节毛细血管和间质之间的液体流动，并减轻由于再灌注引起的液体过载。
