Lactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis
Lactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis
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DOI：
10.1016/j.cgh.2011.04.026
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发表时间：
2011-08-01
影响因子：
12.6
通讯作者：
Conwell, Darwin L.
中科院分区：
文献类型：
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作者：
Wu, Bechien U.;Hwang, James Q.;Conwell, Darwin L.
背景与目的：积极的液体复苏被推荐用于急性胰腺炎的初始管理。我们进行了一项随机对照试验，以评估目标导向的液体复苏方案对急性胰腺炎患者全身炎症的影响。然后，我们确定了乳酸林格氏液复苏的影响，与生理盐水相比。方法：我们对2009年5月至2010年2月在3家新英格兰医院的40例急性胰腺炎患者进行了随机对照试验。患者接受乳酸林格氏液目标导向液体复苏、生理盐水目标导向液体复苏、乳酸林格氏液标准液体复苏或生理盐水标准液体复苏。24 h后根据全身炎症反应综合征（SIRS）水平和C反应蛋白（CRP）水平测定全身炎症。研究结果：在24小时内给予目标导向或标准液体复苏的患者之间的液体体积相似（平均值分别为4300和4600 mL; P = 0.87）。与标准复苏（分别为11.8%和13.0%; P = 0.85）或24小时后CRP水平（分别为87.1和69.2 mg/dL; P = 0.75）相比，目标导向复苏并未显著降低SIRS的发生率。相比之下，与生理盐水相比，使用乳酸林格氏液复苏的受试者在24小时后SIRS显著降低（分别降低84% vs 0%; P = 0.035）;与生理盐水相比，乳酸林格氏液的给药也降低了CRP水平（分别为51.5 vs 104 mg/dL; P = 0.02）。结论：与接受生理盐水复苏的患者相比，接受乳酸林格氏液复苏的急性胰腺炎患者的全身炎症减少。
BACKGROUND & AIMS: Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. We performed a randomized controlled trial to evaluate the impact of a goal-directed fluid resuscitation protocol on systemic inflammation in patients with acute pancreatitis. We then determined the impact of resuscitation with lactated Ringer's solution, compared with normal saline. METHODS: We performed a randomized controlled trial of 40 patients with acute pancreatitis at 3 New England hospitals from May 2009-February 2010. Patients received goal-directed fluid resuscitation with lactated Ringer's solution, goal-directed fluid resuscitation with normal saline, standard fluid resuscitation with lactated Ringer's solution, or standard fluid resuscitation with normal saline. Systemic inflammation was measured on the basis of levels of systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) level after 24 hours. RESULTS: The volumes of fluid administered during a 24-hour period were similar among patients given goal-directed or standard fluid resuscitation (mean, 4300 vs 4600 mL, respectively; P = .87). Goal-directed resuscitation did not significantly reduce incidence of SIRS, compared with standard resuscitation (11.8% vs 13.0%, respectively; P = .85) or levels of CRP after 24 hours (87.1 vs 69.2 mg/dL, respectively; P = .75). By contrast, there was a significant reduction in SIRS after 24 hours among subjects resuscitated with lactated Ringer's solution, compared with normal saline (84% reduction vs 0%, respectively; P = .035); administration of lactated Ringer's solution also reduced levels of CRP, compared with normal saline (51.5 vs 104 mg/dL, respectively; P = .02). CONCLUSIONS: Patients with acute pancreatitis who were resuscitated with lactated Ringer's solution had reduced systemic inflammation compared with those who received saline.