Do Larger Periprocedural Fluid Volumes Reduce the Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis?
Do Larger Periprocedural Fluid Volumes Reduce the Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis?
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DOI：
10.1097/mpa.0000000000000101
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发表时间：
2014-05-01
期刊：
影响因子：
2.9
通讯作者：
Saini, Sameer D.
中科院分区：
文献类型：
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作者：
DiMagno, Matthew J.;Wamsteker, Erik-Jan;Saini, Sameer D.
目的液体治疗是急性胰腺炎（AP）早期治疗的基石，但关于它是否影响疾病严重程度的数据存在争议。在实验性 AP 诱导期间给予更大的液体体积 (FV) 可保留胰腺灌注并降低严重程度，但不能预防 AP 的发生。我们假设在内窥镜逆行胰胆管造影 (ERCP) 期间使用较大的 FV 与 ERCP 后胰腺炎 (PEP) 的严重程度减轻相关。方法在一项回顾性队列研究中，我们确定了 6505 名患者，他们在 1997 年 1 月至 2009 年 3 月期间接受了 8264 次 ERCP；其中 211 名患者出现 PEP（48 名轻度、141 名中度和 22 名重度）。 173 名 PEP 患者的 FV 数据可用。结果在单变量分析中，16 个变量中只有 1 个与中度至重度 PEP 显着相关——围手术期较大的 FV 具有保护作用（0.94 +/- 0.3 L vs 0.81 +/- 0.4 L；P = 0.0129）。同样，中度至重度 PEP 的多变量分析确定了 1 个独立预测因子——较大的围手术期 FV 具有保护作用（比值比，0.20；95% 置信区间，0.05-0.83）。相反，中度至重度疾病与 PEP 诊断后给予较大 FV 相关（反映治疗决策）。结论 这项假设生成研究表明，围手术期给予较大 FV 可预防中度至重度 PEP。关于这个主题的前瞻性研究是有必要的。
ObjectiveFluid therapy is a cornerstone of the early treatment of acute pancreatitis (AP), but data are conflicting on whether it affects disease severity. Administering greater fluid volumes (FVs) during induction of experimental AP preserves pancreatic perfusion and reduces severity but does not prevent onset of AP. We hypothesized that administering larger FV during endoscopic retrograde cholangiopancreatography (ERCP) associates with less severe post-ERCP pancreatitis (PEP).MethodsIn a retrospective cohort study, we identified 6505 patients who underwent 8264 ERCPs between January 1997 and March 2009; 211 of these patients developed PEP (48 mild, 141 moderate, and 22 severe). Data for FVs were available for 173 patients with PEP.ResultsIn univariable analysis, only 1 of 16 variables was significantly associated with moderate to severe PEP-larger periprocedural FV was protective (0.94 +/- 0.3 L vs 0.81 +/- 0.4 L; P = 0.0129). Similarly, multivariable analysis of moderate to severe PEP identified 1 independent predictor-larger periprocedural FV was protective (odds ratio, 0.20; 95% confidence interval, 0.05-0.83). Conversely, moderate to severe disease correlated with larger FV administered after PEP diagnosis (reflecting treatment decisions).ConclusionsThis hypothesis-generating study suggests that administering larger periprocedural FVs is protective against moderate to severe PEP. Prospective studies on this topic are warranted.