虽然大多数急性胰腺炎（AP）的治疗指南和评论建议在患者入院第一天对其进行积极的输液治疗，但目前尚无直接的证据支持。我们的目的是评估入院后最初的24 小时输液量与器官衰竭（OF）发生率、局部并发症和死亡率的之间的相关性。

本研究是一项前瞻性队列研究。研究对象包括因AP连续入院的成年患者。根据亚特兰大分类定义局部并发症和器官衰竭。 持续性器官衰竭指器官衰竭的持续时间超过 48小时。根据最初的24小时内输液量将患者分为三组：A组：<3.1升（小于第一四分位数），B组：3.1-4.1升（第一和第三四分位数之间），C组：大于4.1升（超过第三四分位数）。

共对247例患者进行了分析。最初24小时内输液量> 4.1升与器官衰竭、急性液体积聚、呼吸功能不全以及肾功能不全显著相关，且呈独立性。最初24小时输液量<3.1升与器官衰竭、局部并发症和死亡率均不相关。最初24小时内补液量在3.1和4.1升之间的患者预后良好。

我们的研究表明，最初24小时内少量输液与预后差不相关。最初24小时内大量输液与预后差相关。因此，必须对这组患者进行小心监测。

Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study

OBJECTIVES:Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality.
METHODS:This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile).
RESULTS:A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome.
CONCLUSIONS:In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.