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首页> 外文期刊>ANZ journal of surgery >Intravenous fluid therapy in acute pancreatitis: a critical review of the randomized trials
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Intravenous fluid therapy in acute pancreatitis: a critical review of the randomized trials

机译：急性胰腺炎静脉内液治疗：对随机试验的关键综述

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Introduction Fluid management is a cornerstone of treatment in acute pancreatitis (AP). Methods Identification of existing randomized prospective trials of patients with AP, in which intravenous fluid management was a significant parameter in the experimental design, was undertaken using the PubMed and ENDOBASE databases. Results Included patients in the seven studies identified were on the whole very unwell with deaths occurring in six trials. Fluid regimens in AP included crystalloid alone, combinations of crystalloid and colloid and in two studies, plasma. In most studies, patients with premorbid major organ failure and advanced age were excluded. Study entry within 6 h of presentation occurred in three trials. Initial fluid administration rates varied from 1 to 2 mL/kg/h to 15 mL/kg/h. Rapid fluid rates were associated with increased morbidity and mortality except in one study in which a high fluid regimen (20 mL/kg bolus within 4 h of presentation followed by 3 mL/kg) led to a better clinical outcome than a more conservative regimen. Use of Ringer's lactate led to improved surrogate outcome markers compared to that of normal saline in one study. Administration of colloid as part of the fluid management was associated with lower morbidity and lower fluid requirements. Conclusion Rapid infusion of crystalloid very early in the course of AP may be beneficial but rapid infusion of fluid later in the course of the illness may be deleterious. Colloid administration and the use of Ringer's lactate solution in preference to normal saline may improve outcome.
机译：引言流体管理是急性胰腺炎（AP）中治疗的基石。方法鉴定AP患者现有随机前瞻性试验，其中静脉内流体管理是实验设计中的重要参数，采用PubMed和Endobase数据库进行。结果包括七项研究中患者的患者在六项试验中患有死亡的全部不适。 AP中的液体方案包括单独的晶体，晶体和胶体的组合和两项研究，等离子体。在大多数研究中，排除了预血压主要器官衰竭和晚期年龄的患者。在介绍6小时内发生研究进入三次试验。初始流体给药速率从1-2ml / kg / h变化至15ml / kg / h。除了一项研究中，快速流体率与发病率和死亡率增加有关，除了一个研究，其中高流体方案（在4小时内呈现出3ml / kg的介绍中的20ml / kg推注）导致更好的临床结果而不是更保守的方案。与一项研究中的正常盐水相比，使用林格的乳酸导致改善替代结果标记。作为流体管理的一部分施用胶体与较低的发病率和较低的流体要求相关。结论在AP过程中快速输注晶体的早期可能是有益的，但在疾病过程中后来的液体迅速输注可能是有害的。胶体给药和使用林格的乳酸溶液优先于生理盐水可以改善结果。

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