| objective:Severe acute pancreatitis is a dangerous disease in clinic with a high mortality rate.Early fluid resuscitation is the most important measure for the treatment of severe acute pancreatitis,but there is no unified standard for the specific method of early fluid resuscitation in clinic,and there is a big controversy.By collecting the existing clinical research data,this study conducted a meta-analysis on the treatment effect and prognosis of early restricted and large-capacity liquid resuscitation therapy and liquid resuscitation with different proportion of crystals and colloids on severe acute pancreatitis,so as to provide a reference for clinical treatment of severe acute pancreatitis with liquid resuscitation.Methods:Chinese and English data such as CBM,wanfang digital journal full-text database,cnki,PubMed,Cochrane library clinical controlled trial database were searched by computer,the results were screened,the quality was controlled,and the statistical analysis was conducted.Results:part I:The mortality of the two groups was compared with 10reference.The mortality rate of the two groups was 10.1%(116/1148)in the restricted fluid resuscitation group,which was 15.7%(114/726)in the large volume fluid resuscitation group.There was no significant heterogeneity between the two groups(I~2=24%).The fixed-effect model was used,and the results showed that the difference between the two groups was statistically significant[OR=0.60,95%CI(0.46-0.80),P=0.0004].five literatures were included to compare the incidence of MODS in the two groups.The incidence of multiple organ failure in the restricted fluid resuscitation group was21.0%(58/276),which was lower than that in the large volume fluid resuscitation group 33.5%(67/200).There was significant heterogeneity between the two groups(I~2=68%),and the random effect model was adopted.The results showed that the difference between the two groups was not statistically significant[OR=0.46,95%CI(0.19-1.12),P=0.09].When li xiaofeng's literature was excluded,the heterogeneity decreased significantly to 38%.The results showed that the MODS occurrence in the restricted fluid resuscitation group was lower than that in the large-volume fluid group,and the results were statistically significant[OR=0.55,95%ci(0.35-0.87),P=0.01].Into four articles on two groups of patients to compare the incidence of AKI,restrictive fluid resuscitation group,the incidence of AKI 12.4%(116/938)below the large capacity liquid resuscitation group,the incidence of AKI 27.8%(154/554),no obvious heterogeneity between groups(I~2=30%),using the fixed effects model,results show that the differences between the two groups have statistical significance(OR=0.41,95%CI(0.31,0.54),P<0.00001).Seven literatures were included to compare the incidence of ACS,and the incidence of ACS in the restricted fluid resuscitation group was 15.8%(46/292),which was lower than that in the large volume fluid resuscitation group(43.3%(84/194)).There was no heterogeneity between the two groups(I~2=0%),and the fixed effect model was adopted.The results showed that the difference between the two groups was statistically significant[OR=0.23,95%CI(0.14-0.38),P<0.00001].Three literatures were included to compare the length of stay between the two groups.There was no heterogeneity between the two groups(I~2=1%).The combined results showed that full large-volume fluid resuscitation could shorten the length of stay.The difference between the two groups was statistically significant[MD=8.91,95%CI(6.19-11.64),P<0.00001].Into 4paper analyzes the third interstitial fluid retention amount after recovery,no heterogeneity between groups(I~2=0%),using the fixed effects model,the results showed limited fluid resuscitation group recovery after the third interstitial fluid retention amount is lower than the large capacity liquid resuscitation group,the differences between the two groups have statistical significance[SMD=0.6,95%CI(0.87,0.33),P<0.00001).Nine articles were included to compare the incidence of mechanical ventilation between the two groups.The rate of mechanical ventilation in the restricted fluid resuscitation group was 21.2%(229/1081)lower than that in the large volume fluid resuscitation group(50.4%(336/667),and there was inter-group heterogeneity(I~2=72%).The results showed that the difference between the two groups was statistically significant[OR=0.25,95%CI(0.13,0.47),P=0.0004].Six literatures were included to compare the APACHEII scores of the two groups after treatment,and there was heterogeneity between the two groups(I~2=58%).The results showed that the APACHEII score of restricted fluid resuscitation was significantly better than that of the large-volume fluid resuscitation group after treatment,and the difference between the two groups was statistically significant[MD=-0.79,95%CI(-1.01,-0.57),P<0.00001].Part II:five literatures were included to analyze the total fluid rehydration volume of patients in the two groups at 72h,and the results showed that the total fluid volume in the low crystalline-gel ratio group at 72h was significantly lower than that in the high crystalline-gel ratio group,with statistical significance[MD=-3610.48,95%CI(-4613.48,-2607.48),P<0.00001].Heterogeneity was found between groups(I~2=91%).Four literatures were included to analyze the24h liquid retention,and the results showed that the 24h liquid retention in the low crystalline-gel ratio group was significantly lower than that in the high crystalline-gel ratio group,with statistical significance[MD=-890.95,95%CI(-1303.02,-478.88),P<0.0001],and heterogeneity(I~2=95%).Into 2paper analyzes mechanical ventilation rate,results show that the mechanical ventilation rate lower than crystal glue group was obviously lower than Gao Jing glue group,with statistical significance(OR=0.11,95%CI(0.05,0.28),P<0.00001,no heterogeneity between groups(I~2=0%).Included in the four studies and analysis of mortality,according to the results in a lower mortality than crystal glue group was obviously lower than Gao Jing glue group,have statistical significance(OR=0.18,95%CI(0.07,0.45),P=0.0002).There are heterogeneous(I~2=54%),Into four articles for 3 days before the recovery BNP levels were analyzed,and the results showed that 1 day BNP levels lower than crystal glue group was obviously lower than Gao Jing glue group was statistically significant(MD=187.74,95%CI(311.19,64.289),P=0.003),there is heterogeneity(I~2=99%),2 days by BNP levels lower than crystal glue group was obviously lower than Gao Jing glue group was statistically significant[MD=-238.17,95%CI(-244.76,-231,57),P<0.00001].There was no heterogeneity(I~2=11%).BNP level in the low crystalline-gel ratio group was significantly lower than that in the high crystalline-gel ratio group on the3rd day,with statistical significance[MD=-206.76,95%CI(-341.94,-71.59),P=0.003].There was heterogeneity(I~2=100%).Conclusion:1.Early restricted fluid resuscitation in severe acute pancreatitis can effectively reduce the incidence and mortality of ACS,mechanical ventilation,AKI,reduce the amount of fluid retention in the third gap,reduce the APACHEII score after treatment,and improve the prognosis.Large volume fluid resuscitation can shorten the total length of hospital stay.However,there was no statistically significant difference between the two groups in reducing the incidence of MODS.2.The low crystal-gel ratio(<3:1)was lower than the high crystal-gel ratio(>3:1)for 72h total fluid volume,24h fluid retention,BNP level for 3consecutive days,mortality rate and mechanical ventilation rate. |
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