急性胰腺炎的液体治疗:复苏时机、液体种类及监测方法

吴东; 钱家鸣

doi:10.3969/j.issn.1001-5256.2017.01.001

急性胰腺炎的液体治疗:复苏时机、液体种类及监测方法

DOI: 10.3969/j.issn.1001-5256.2017.01.001

吴东,
钱家鸣

中国医学科学院北京协和医学院北京协和医院消化科

详细信息

中图分类号: R576
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出版历程
- 收稿日期: 2016-09-22
- 出版日期: 2017-01-20

Fluid therapy for acute pancreatitis: timing of resuscitation,type of fluid,and monitoring methods

Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences

摘要

摘要:
胰腺微循环障碍和缺血是急性胰腺炎起病阶段重要的病理生理改变,器官灌注不足是该病预后不良的危险因素。在入院后最初12~24 h液体复苏是急性胰腺炎早期最重要的内科治疗方法,及时而合理地补液有助于改善预后。但关于液体种类、输液速度及监测手段仍缺乏高质量的临床证据,有待更多的随机对照试验加以研究。
- 胰腺炎 /
- 液体治疗 /
- 述评
Abstract:
Microcirculation disturbance and ischemia of the pancreas are important pathophysiological changes in the onset of acute pancreatitis,and organ hypoperfusion is a risk factor for poor prognosis. During the first 12 to 24 hours after admission,fluid resuscitation is the most important medical treatment for the early stage of acute pancreatitis,and timely and rational fluid infusion helps to improve prognosis.However,there lacks high- quality clinical evidence for type of fluid,infusion speed,and monitoring methods,and more randomized controlled trials are needed.
- pancreatitis /
- fluid therapy /
- editorial

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参考文献(34)

[1] Pancreas Study Group,Chinese Society of Gastroenterology,Chinese Medical Association,Editorial Board of Chinese Journal of Pancreatology,Editorial Board of Chinese Journal of Digestion.Chinese guidelines for the management of acute pancreatitis(Shanghai,2013)[J].J Clin Hepatol,2013,29(9):656-660.(in Chinese)中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J].临床肝胆病杂志,2013,29(9):656-660.

[2]PEERY AF,DELLON ES,LUND J,et al.Burden of gastrointestinal disease in the United States:2012 update[J].Gastroenterology,2012,143(5):1179-1187.

[3]LANKISCH PG,APTE M,BANKS PA.Acute pancreatitis[J].Lancet,2015,386(9988):85-96.

[4]TENNER S,BAILLIE J,DEWITT J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1415.

[5] BANKS PA,BOLLEN TL,DERVENIS C,et al.Classification of acute pancreatitis—2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.

[6]WU D,LU B,YANG H,et al.The three-category classification of severe acute pancreatitis:a single-center pilot study[J].Chin J Intern Med,2014,53(12):937-940.(in Chinese)吴东,芦波,杨红,等.重症急性胰腺炎三分类的单中心探索研究[J].中华内科杂志,2014,53(12):937-940.

[7] Professional Committee of Pancreatic Disease,Chinese Medical Doctor Association.Chinese consensus on the multidisciplinary treatment(MDT)of acute pancreatitis[J].J Clin Hepatol,2015,31(11):1770-1775.(in Chinese)中国医师学会胰腺病学专业委员会.中国急性胰腺炎多学科诊治共识意见[J].临床肝胆病杂志,2015,31(11):1770-1775.

[8] Group of Pancreas Surgery,Chinese Society of Surgery,Chinese Medical Association.Guidelines for the management of acute pancreatitis(2014)[J].J Clin Hepatol,2015,31(1):17-20.(in Chinese)中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].临床肝胆病杂志,2015,31(1):17-20.

[9]Working Group IAP/APA Acute Pancreatitis Guidelines.IAP/APA evidence-based guidelines for the management of acute pancreatitis[J].Pancreatology,2013,13(4 Suppl 2):e1-e15.

[10]GARDNER TB,VEGE SS,PEARSON RK,et al.Fluid resuscitation in acute pancreatitis[J].Clin Gastroenterol Hepatol,2008,6(10):1070-1076.

[11]TAKEDA K,MIKAMI Y,FUKUYAMA S,et al.Pancreatic ischemia associated with vasospasm in the early phase of human acute necrotizing pancreatitis[J].Pancreas,2005,30(1):40-49.

[12]SCHMIDT J,HUCH K,MITHFER K,et al.Benefits of various dextrans after delayed therapy in necrotizing pancreatitis of the rat[J].Intensive Care Med,1996,22(11):1207-1213.

[13]STRATE T,MANN O,KLEINHANS H,et al.Microcirculatory function and tissue damage is improved after therapeutic injection of bovine hemoglobin in severe acute rodent pancreatitis[J].Pancreas,2005,30(3):254-259.

[14]BROWN A,ORAV J,BANKS PA.Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis[J].Pancreas,2000,20(4):367-372.

[15]WU BU,JOHANNES RS,CONWELL DL,et al.Early hemoconcentration predicts increased mortality only among transferred patients with acute pancreatitis[J].Pancreatology,2009,9(5):639-643.

[16]MUDDANA V,WHITCOMB DC,KHALID A,et al.Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis[J].Am J Gastroenterol,2009,104(1):164-170.

[17]WU BU,JOHANNES RS,SUN X,et al.Early changes in blood urea nitrogen predict mortality in acute pancreatitis[J].Gastroenterology,2009,137(1):129-135.

[18]WU BU,BAKKER OJ,PAPACHRISTOU GI,et al.Blood urea nitrogen in the early assessment of acute pancreatitis:an international validation study[J].Arch Intern Med,2011,171(7):669-676.

[19]KLAR E,FOITZIK T,BUHR H,et al.Isovolemic hemodilution with dextran 60 as treatment of pancreatic ischemia in acute pancreatitis.Clinical practicability of an experimental concept[J].Ann Surg,1993,217(4):369-374.

[20]BROWN A,BAILLARGEON JD,HUGHES MD,et al.Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis?[J].Pancreatology,2002,2(2):104-107.

[21]ECKERWALL G,OLIN H,ANDERSSON B,et al.Fluid resuscitation and nutritional support during severe acute pancreatitis in the past:what have we learned and how can we do better?[J].Clin Nutr,2006,25(3):497-504.

[22]REDDY N,WILCOX CM,TAMHANE A,et al.Protocol-based medical management of post-ERCP pancreatitis[J].J Gastroenterol Hepatol,2008,23(3):385-392.

[23]MAO EQ,TANG YQ,FEI J,et al.Fluid therapy for severe acute pancreatitis in acute response stage[J].Chin Med J(Engl),2009,122(2):169-173.

[24]GARDNER TB,VEGE SS,CHARI ST,et al.Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality[J].Pancreatology,2009,9(6):770-776.

[25]MAO EQ,FEI J,PENG YB,et al.Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis[J].Chin Med J(Engl),2010,123(13):1639-1644.

[26]DU XJ,HU WM,XIA Q,et al.Hydroxyethyl starch resuscitation reduces the risk of intra-abdominal hypertension in severe acute pancreatitis[J].Pancreas,2011,40(8):1220-1225.

[27]de-MADARIA E,SOLER-SALA G,SNCHEZ-PAYJ,et al.Influence of fluid therapy on the prognosis of acute pancreatitis:a prospective cohort study[J].Am J Gastroenterol,2011,106(10):1843-1850.

[28]WU BU,HWANG JQ,GARDNER TH,et al.Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis[J].Clin Gastroenterol Hepatol,2011,9(8):710-717.

[29]WARNDORF MG,KURTZMAN JT,BARTEL MJ,et al.Early fluid resuscitation reduces morbidity among patients with acute pancreatitis[J].Clin Gastroenterol Hepatol,2011,9(8):705-709.

[30]WALL I,BADALOV N,BARADARIAN R,et al.Decreased mortality in acute pancreatitis related to early aggressive hydration[J].Pancreas,2011,40(4):547-550.

[31]MOLE DJ,HALL A,Mc KEOWN D,et al.Detailed fluid resuscitation profiles in patients with severe acute pancreatitis[J].HPB(Oxford),2011,13(1):51-58.

[32]WEITZ G,WOITALLA J,WELLHONER P,et al.Detrimental effect of high volume fluid administration in acute pancreatitis-a retrospective analysis of 391 patients[J].Pancreatology,2014,14(6):478-483.

[33]SUN Y,LU ZH,ZHANG XS,et al.The effects of fluid resuscitation according to Pi CCO on the early stage of severe acute pancreatitis[J].Pancreatology,2015,15(5):497-502.

[34]HAYDOCK MD,MITTAL A,WILMS HR,et al.Fluid therapy in acute pancreatitis:anybody's guess[J].Ann Surg,2013,257(2):182-188.

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