The Treatment Effectiveness Of Fluid Management On Severe Acute Pancreatitis

BackgroundThe mortality of severe acute pancreatitis(SAP)is still very high.Fluid management is the cornerstone of entire therapeutic process.After combining clinical researches with years of clinical experience,Ruijin Hospital has proposed its own fluid management plan.The plan is divided into early controlling fluid resuscitation strategy and later fluid regulating strategy.AimThe study aims at assessing the effect of early controlling fluid resuscitation strategy on the prognosis of SAP and the relationship between extrinsic fluid intake and extra-pancreatic exudates.MethodsFirst phase: 61 patients diagnosed with SAP treated in ICU within 72 hours after attack between 2012 and 2017 were included and divided into accomplished group and unaccomplished group according to whether or not accomplishing the early controlling fluid resuscitation strategy.Accomplished group included 38 patients and unaccomplished group included 23 patients.Prognoses of the patients were compared.Second phase: Investigating the relationship between extrinsic fluid intake and extra-pancreatic exudates change by three dimensional reconstruction and linear regression analysis.Multivariable linear regression was used to detect the influence factors that may influence the relationship.ResultsThere was no obvious baseline deviation between two groups.Patients in accomplished group had lower mortality rate within 90 days than the unaccomplished group(18.4% vs 47.8%;p<0.05)and also lower incidence of renal failure within 7 days(21% vs 60.8%;p<0.05),surgical intervention(23.6% vs 56.5%;p<0.05)and superior APACHEII and CTSI score trend.Duration of mechanical ventilation,incidence of pulmonary and circulatory failure within 7 days in both groups were of no difference.Extra-pancreatic exudates change during a period of time was significantly positively correlated with daily intravenous fluid administration(r=0.493;p<0.05)but not correlated with total net fluid intake(r=0.059;p=0.621),daily net fluid intake(r=0.078;p=0.516)or total intravenous fluid administration(r=0.054;p =0.654).Abdominocentesis and percutaneous peri-pancreatic drainage could reduce the extra-pancreas exudates effectively(p<0.05).ConclusionSAP patients accomplished early controlling fluid resuscitation strategy,compared with unaccomplished group patients,have lower mortality rate within 90 days,lower incidence of renal failure within 7 days,surgical intervention,and superior APACHEII and CTSI score trend.Extra-pancreatic exudates change during a period of time was significantly positively correlated with daily intravenous fluid.Abdominocentesis and percutaneous peri-pancreatic drainage could effectively reduce the extra-pancreatic exudates.