Therapy Of Controlled Fluid Resuscitation For Severe Acute Pancreatitis In Acute Phase

[Background] severe acute pancreatitis (severe acute pancreatitis, SAP) is a rapidly progressive disease,and which has high mortality rate among the common severe abdominal diseases. the disease's clinical manifestations are diverse, and a variety of complications can occur, such as hypovolemic shock, multiple organ dysfunction syndrome (Multiple Organ disfunction syndrome, MODS), acute respiratory distress syndrome (acute respiratory distension syndrome, ARDS) and so on. In the recent years, although the treatments of SAP have significantly improved,its mortality about 20%. the acute response phase of SAP is a death peak.in this phase,The whole body suffers from the inflammatory syndrome (SIRS) state, where a large number of fluid loss in intercellar space, resulting in short time Fluid imbalance therefore, looking for the fluid resuscitation methods to improve the cure rate of SAP in the acute response phase has important significance.[Objective]:To compare the therapy between the controlled fluid resuscitation and fast fluid resuscitation for severe actue pancreatitis in actue response phase,as well as to provide a reasonable method for clinical treatment.[Methods]:There are 35 inpatients meeting the diagnostic criteria of severe acute pancreatitis in our hospital fromJanuary 2008 to February 2010, including 22 males and 13 females. according to the time of Expansion Standards,after admission they were divided into rapid expansion expansion group (I group, within 24 hours of admission,16 patients),and controlled expansion group (II group, from 24 to 72 hours of admission,19 cases).According to the rapid fluid resuscitation and controlled fluid resuscitation treatment, Some indicators were observed within 72 hours after admission,such as hematocrit (HCT), infusion rate, total fluid retention (from admission to 72h the transfusion volume minus total body excretion of body fluids), amylase decline, acute and Chronic Health Evaluation (APACHE II score), the time of intestinal function (exhaust), pulmonary complications, mechanical ventilation rate, the incidence of abdominal compartment syndrome, the time of abdominal pain began to ease, the time of ECG monitoring,the cure rate and other indicators. Using SPSS 13.0 statistical software to analyze the data, Measurement datas were presented as mean±standard deviation using the t test, count data samples compared by x2 test, P<0.05 was statistically significant for the difference.[Results] The hematocrit (HCT) of group I was significantly lower than groupⅡ(P<0.05), the two groups was statistically significant; decrease of amylase in group I was significantly lower than groupⅡ(P<0.05); from admission to expansion of Standards time, groupⅠwas significantly shorter than GroupⅡ(P<0.05);On day 1 of admission, the infusion rate in groupⅠwas significantly higher than the groupⅡ(P<0.05), after expansion of Standards, the infusion speed of two groups was no significant difference (P> 0.05);the time of intestinal function (exhaust) in group I was significantly longer than II group (P<0.05); fluid retention in group II was significantly lower than group I (P<0.05); the time of abdominal pain began to ease in group I was significantly longer than II group (P<0.05); breathing machine utilization rate in group I was significantly higher than II group (P<0.05); ECG time in group I was significantly longer than II group (P<0.05); admission was no significant difference between the two groups (P> 0.05), after expansion of compliance,the APACHE II score in group I was significantly higher than II group (P<0.05); the cure rate in group I was significantly lower than II group (P<0.05).[Conclusion]1:Controlled fluid resuscitation is suitable for the patients of SAP within 72h, A reasonable proportion of crystal and colloid is 2:1 to 1.5:1,but when negative fluid balance occurs, its ratio is up to 1:1 or even 1:2.3.2:The infusion rate of controlled fluid resuscitation was changed in order to slowly ease the hemodynamic disorders of SAP:the heart rate began to slow down (less than 120 beats/min), MAP tended to be normal (90/60mmHg) and HCT is between (30-35%).3:Controlled fluid resuscitation not only can reduced tissue hypoxia time,but also can prevent capillary leakage syndrome (CLS),controlling blood volume expansion and prevention fluid retention can inprove the survival rate of patients.