Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis
Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis
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DOI：
10.1038/ajg.2017.40
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发表时间：
2017-05-01
影响因子：
9.8
通讯作者：
Laine, Loren
中科院分区：
文献类型：
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作者：
Buxbaum, James L.;Quezada, Michael;Laine, Loren
目的：早期积极的静脉补液被推荐用于急性胰腺炎的治疗，尽管随机试验尚未证明其益处。我们进行了一项在轻度急性胰腺炎初始管理中积极与标准水化的随机试验。60例无全身炎症反应综合征（SIRS）或器官衰竭的急性胰腺炎患者在诊断后4小时内被随机分为积极治疗组和积极治疗组。（20 ml/kg推注，随后为3 ml/kg/h）与标准（10 ml/kg推注，随后为1.5 mg/kg/h）乳酸林格氏溶液水合。每隔12小时对患者进行评估。在每个时间间隔，两组中，如果红细胞压积、血尿素氮（BUN）或肌酐升高，则推注20 ml/kg，随后3 ml/kg/h;如果实验室检查结果降低且上腹痛减轻（以0-10视觉模拟量表测量），则以1.5 ml/kg/h进行水合，并开始进食透明液体。主要终点，36小时内的临床改善，被定义为降低红细胞压积，BUN和肌酐的组合;改善疼痛;和口服diet.RESULTS的耐受性：患者的平均年龄为45岁，只有14（23%）的合并症。与标准水化相比，接受积极水化治疗的患者在36 h时显示出更高比例的临床改善：70 vs. 42%（P=0.03）。通过考克斯回归分析，积极水化治疗的临床改善率高于标准水化治疗：校正风险比=2.32，95%置信区间1.21-4.45。与血液浓缩（11.1 vs. 36.4%，调整后OR =0.08，0.01-0.49）一样，持续性SIRS在积极水化（7.4 vs. 21.1%;调整后OR=0.12，0.02-0.94）中的发生率较低。没有患者出现容量超负荷的迹象。结论：早期积极的乳酸林格氏液静脉补液可加速轻度急性胰腺炎患者的临床改善。
OBJECTIVES: Early aggressive intravenous hydration is recommended for acute pancreatitis treatment although randomized trials have not documented benefit. We performed a randomized trial of aggressive vs. standard hydration in the initial management of mild acute pancreatitis.METHODS: Sixty patients with acute pancreatitis without systemic inflammatory response syndrome (SIRS) or organ failure were randomized within 4 h of diagnosis to aggressive (20 ml/kg bolus followed by 3 ml/kg/h) vs. standard (10 ml/kg bolus followed by 1.5 mg/kg/h) hydration with Lactated Ringer's solution. Patients were assessed at 12-h intervals. At each interval, in both groups, if hematocrit, blood urea nitrogen (BUN), or creatinine was increased, a bolus of 20 ml/kg followed by 3 ml/kg/h was given; if labs were decreased and epigastric pain was decreased (measured on 0-10 visual analog scale), hydration was then given at 1.5 ml/kg/h and clear liquid diet was started. The primary endpoint, clinical improvement within 36 h, was defined as the combination of decreased hematocrit, BUN, and creatinine; improved pain; and tolerance of oral diet.RESULTS: The mean age of the patients was 45 years and only 14 (23%) had comorbidities. A higher proportion of patients treated with aggressive vs. standard hydration showed clinical improvement at 36 h: 70 vs. 42% (P=0.03). The rate of clinical improvement was greater with aggressive vs. standard hydration by Cox regression analysis: adjusted hazard ratio=2.32, 95% confidence interval 1.21-4.45. Persistent SIRS occurred less commonly with aggressive hydration (7.4 vs. 21.1%; adjusted odds ratio (OR)=0.12, 0.02-0.94) as did hemoconcentration (11.1 vs. 36.4%, adjusted OR=0.08, 0.01-0.49). No patients developed signs of volume overload.CONCLUSIONS: Early aggressive intravenous hydration with Lactated Ringer's solution hastens clinical improvement in patients with mild acute pancreatitis.