| Objective:This study systematically studied the effect of early fluid balance management on clinical prognosis in patients with severe pancreatitis,in order to provide more evidence-based medicine of early fluid balance in patients with severe pancreatitis.Method:The clinical data of 236 patients with severe pancreatitis admitted to the intensive care unit of the affiliated Hospital of qingdao university from January 2017 to June 2019 were selected and analyzed.Patients meeting the criteria for severe pancreatitis were selected,which was the Aatlanta classification criteria revised by the international symposium on acute pancreatitis.The time of admission should be less than 72 h from the time of onset.Patients with severe pancreatitis were divided into experimental group(total positive fluid balance ≥40m L/kg)and control group(total positive fluid balance <40m L/kg)according to the target fluid resuscitation balance volume at early stage(24h after admission).Clinical data including gender,age,etiology of pancreatitis,and the type and quantity of liquid infusion within 24 h after admission were collected.In this study,the primary endpoint were mortality,and the secondary endpoints included mechanical ventilation rate,blood purification rate,improvement rate of systemic inflammatory response syndrome,incidence of abdominal hypertension,improvement rate of organ dysfunction,and incidence of pancreatic pseudocyst.Result:1.A total of 236 patients with severe pancreatitis were included,including 118 in the experimental group and 118 in the control group.Among the 236 patients with severe pancreatitis included in this study,the proportion of alcoholic pancreatitis and hyperlipidemic pancreatitis was similar,while the proportion of gallbladder pancreatitis was relatively low,which may be because of regional differences.2.In this study,the total amount of liquid input in the experimental group at 24 h after admission was 5280.49±604.86 m L,and that in the control group was 3080.90±556.68 m L,the difference was statistically significant(P<0.05).The total positive balance amount of liquid in the two groups was 4076.55±542.27 m L(57.12±7.31 m L/Kg)and 2294.16±421.90 m L(31.61±5.85 m L/Kg),and the average amount of liquid input in the experimental group was 1800 m L.3.The mortality rate in experimental group was significantly higher than that in control group(25.4% vs.13.6%,P=0.02),and the improvement rate of organ failure in experimental group was significantly lower than that in control group(69.5% vs.84.7%,P<0.05).The proportion of patients with mechanical ventilation(30.5% vs.17.8%),the proportion requiring blood purification(36.4% vs.21.2%)and the incidence of abdominal hypertension(44.1% vs.23.7%)were significantly increased due to the total positive liquid balance ≥3000m L,and the difference between the two groups was statistically significant(P<0.05).More fluid infusion(total positive balance ≥40m L/kg)resulted in an increase in the proportion of SIRS improvement(63.5% vs.52.5%)and an increase in the incidence of pancreatic pseudocyst(33.1%vs.22.1%),but there was no statistically significant difference(P=0.08).4.Multivariate Logisitic regression analysis showed that age,APACHE II score,and 24 h fluid balance ≥40m L/kg were independent risk factors for mortality in patients with severe pancreatitis.Conclusion:Positive fluid balance ≥40m L/kg within 24 hours of admission can increase the mortality rate of patients with severe pancreatitis,reduce the improvement rate of organ failure,increase the proportion of patients with mechanical ventilation,the proportion of patients needing blood purification,and the incidence of abdominal hypertension.The clinician should reasonably manage the fluid balance amount after comprehensive evaluation. |
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