Ehsan Muhammad, Ahmad Aamna Badar, Javed Haseeba, Zahid Afra, Aamir Hafiz Sheheryar, Cheema Huzaifa Ahmad, Ayyan Muhammad, Mustafa Biah, Shahid Abia, Ilyas Muhammad Abdullah, Kandel Kamal, Awan Rehmat Ullah, Iqbal Sana
Department of Medicine King Edward Medical University Lahore Pakistan.
Department of Gastroenterology King Edward Medical University Lahore Pakistan.
JGH Open. 2024 Dec 13;8(12):e70073. doi: 10.1002/jgh3.70073. eCollection 2024 Dec.
A conservative strategy is the primary modality of treatment for acute pancreatitis of which fluid replacement is an important component. Since the results regarding early aggressive versus moderate fluid replenishment for acute pancreatitis are inconsistent, we sought to compare outcomes between the two resuscitation strategies in our meta-analysis.
We searched MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov for all available randomized controlled trials (RCTs) assessing outcomes for patients treated with aggressive fluid replacement compared to moderate fluid replacement. Our primary outcome was all-cause mortality.
Our meta-analysis included 6 RCTs involving a total of 632 patients. Our results showed that aggressive fluid resuscitation increased the risk of all-cause mortality as compared to moderate fluid replacement (RR 2.40, CI: 1.38-4.19). For all of our secondary outcomes which included the development of organ failure, severe pancreatitis, pancreatic necrosis, clinical improvement, development of SIRS, persistent SIRS, and length of hospital stay, the results indicate that there was no significant difference between the two groups.
Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis. RCTs with larger sample sizes are needed to provide greater statistical power and establish more definitive conclusions.
保守治疗策略是急性胰腺炎的主要治疗方式，其中液体补充是重要组成部分。由于急性胰腺炎早期积极补液与适度补液的结果不一致，我们试图在荟萃分析中比较两种复苏策略的疗效。
我们检索了MEDLINE（PubMed）、Embase、Cochrane图书馆和ClinicalTrials.gov，以查找所有评估积极补液与适度补液治疗患者疗效的随机对照试验（RCT）。我们的主要结局是全因死亡率。
我们的荟萃分析纳入了6项RCT，共632例患者。结果显示，与适度补液相比，积极液体复苏增加了全因死亡率（RR 2.40，CI：1.38 - 4.19）。对于我们所有的次要结局，包括器官衰竭的发生、重症胰腺炎、胰腺坏死、临床改善、全身炎症反应综合征（SIRS）的发生、持续性SIRS以及住院时间，结果表明两组之间无显著差异。
与适度补液相比，急性胰腺炎患者积极液体复苏与更高的死亡率相关。需要更大样本量的RCT以提供更大的统计效力并得出更明确的结论。
