Preliminary Impact Of The Initial Fluid Resuscitation With Different Volume On The Prognosis Of Acute Pancreatitis Not Match The Standard Of Severe AP

Objective:To investigate the impact of initial fluid resuscitation(FR)with different fluid infusion rate on the prognosis of acute pancreatitis(NSAP),then to explore an effective way of initial fluid resuscitation in AP therapy.Methods:Clinical Data of 117 patients diagnosed acute pancreatitis in department of gastroenterology,Third People’s Hospital of Chengdu were included in a prospective analysis,department of gastroenterology,Third People’s Hospital of Chengdu,From January 1,2019 to June 30,2020.According to total volume of fluid resuscitation in the first 24h at admission,patients were randomly divided into two groups:low speed FR group(10ml/kg/h)and high speed FR group(15ml/kg/h).The duration of abdominal pain(hours),gender(male/female),age(years),etiology,BMI index(kg/m2),histories of smoking and alcohol intaken,pre-hospital treatment,previous pancreatitis and history of chronic pancreatitis were recorded.Also,family history of pancreatitis,history of cholecystectomy,history of pancreatic surgery and other abdominal surgery were recorded.Urea nitrogen(mmol/L)index,pancreatic CT value and blood lipid(mmol/L)level were recorded after admission;bisap score was calculated(according to blood urea nitrogen,disturbance of consciousness(Glasgow Coma scale score,the highest score was15 points,i.e.clear consciousness)The incidence of SIRS,age and pleural effusion were calculated.The temperature(℃),heart rate(BPM),respiration(BPM),blood pressure(mm Hg)and urine volume(ml/h)were recorded at admission,at the beginning of fluid resuscitation,2 hours and 4 hours after fluid resuscitation,and every 4 hours to 72 hours after fluid resuscitation.The time of reaching the standard of vital signs(mean arterial pressure 65-85beats/min,heart rate less than 120 beats/min,urine volume 1ml/kg/h,two of the three standards are regarded as reaching the standard of vital signs)and the total amount of rehydration 24 hours after admission,48 hours after admission and 72 hours after admission were recorded in detail.Hemoglobin(g/L),hematocrit(L/L),platelet(×10~9/L),leukocyte(×10~9/L),neutrophil ratio(%),creatinine(umol/L),blood glucose(mmol/L),blood lactic acid(mmol/L)and C-reactive protein(mg/L)were recorded at admission and every 12 hours to 72 hours after admission.The incidence of systemic inflammatory response syndrome(SIRS)and multiple organ dysfunction syndrome(MODS)were recorded,Mods,fasting and water deprivation time(days),total hospital stay(days),local and systemic complications of pancreas,invasive(interventional)operation,mechanical ventilation,death and transfer to ICU for treatment,incidence of severe acute pancreatitis 3 days after admission and 7 days after admission,and total hospitalization expenses.Timing of FR(immediate FR at ER,normal FR after hospitalization)and initial evaluating severeity of AP were also analylised.All patients were given treatment such as acid inhibition,inhibition of pancreatic enzyme secretion and anti infection.Results:No statistical difference found in BMI,etiology,pre hospital treatment,BISAP score,blood lipid level at admission and creatinine level at admission between the two groups;nither in the total amount of rehydration 24hours after admission,48 hours after admission,72 hours after admission,the use of acid inhibitors,antibiotics and pancreatic enzyme secretion inhibition therapy between the two groups.The time VS reaching standard was significantly better in high speed group than low;The total cost of hospitalization(yuan)(11323.48±4451.26 vs 11266.22±3647.12,P=0.945),the total length of hospital stay(days)(8.12±3.80 vs 7.77±4.81,P=0.679),the incidence of SIRS(21.74%vs 18.75%,P=0.817),the invasive intervention rate(15.94%vs 12.50%,P=0.791),the mechanical ventilation rate(2.90%vs4.17%,P=0.817)and the incidence of complications in the low rate rehydration group and the high rate rehydration group were significantly higher than those in the control group,There was no significant difference between the two groups(P>0.05).For MAP patients enrolled,high-rate fluid replacement was superior to low-rate fluid replacement(P=0.016)in terms of shortening the time of fasting and water abstinence(P=0.000)and reducing the rate of invasive procedures.However,the total hospitalization time(P=0.161),the ratio of mechanical ventilation(P=0.465),the ratio of intensive care unit(P=0.465),the incidence of SIRS(P=0.685),the incidence of MODS(P=0.597),the proportion of death(P=1.000)and the ratio of conversion to SAP within 3 days of admission(P=0.37)1)There was no statistical difference in SAP conversion rate 7 days after admission and 7 days after admission(P=0.219),P>0.05.For enrolled MSAP patients,high-rate fluid replacement was superior to low-rate fluid replacement in reducing the incidence of SIRS(P=0.031).However,the time of fasting and water deprivation(P=0.468),the rate of reduced invasive procedures(P=0.370),the total length of hospital stay(P=0.053),the rate of mechanical ventilation(P=1.000),the rate of referrals to intensive care unit(P=1.000),the incidence of MODS(P=1.000),the rate of death(P=0.590),and admission to hospital were significantly higher There was no significant difference in the proportion of conversion to SAP within 3 days(P=0.131)and conversion to SAP within 7 days after admission(P=0.079),with P>0.05.Compared with fluid resuscitation,the incidence of multiple organ failure(0 vs 8.33%,P=0.026),total fasting and water deprivation time(days)(3.46±2.47 vs 4.51±2.83;P=0.037),total hospital stay(days)(7.04±3.88 vs 8.62±4.37;P=0.037)were significantly higher;042)and the incidence of severe acute pancreatitis 7 days after admission(4.17%vs 14.49%,P=0.003),and immediate fluid resuscitation in emergency department was superior.The time of reaching the standard of vital signs(minutes)(198.75±100.67 vs 157.12±140.24,P=0.080),the incidence of SIRS(18.75%vs 21.74%,P=0.817),and the proportion of pancreatic local and systemic complications requiring invasive operation(intervention)(14.58%vs 7.25%,P=0.227),mechanical ventilation rate(0 vs 8.70%,P=0.080),transfer to intensive care treatment rate(all 0),mortality rate(all 0),3-day conversion to severe acute pancreatitis rate(14.58%vs 7.25%,P=0.227),total cost after admission(yuan)(10477.59±3001.79 vs 14005.94±4374.98,P=0.314)had no significant difference.The results of hyperlipidemic acute pancreatitis and non hyperlipidemic acute pancreatitis showed that the creatinine value 72 hours after admission in hyperlipidemia group was superior to that in non hyperlipidemia group,P=0.044,There were statistically significant differences in hospitalization expenses(P=0.973),length of stay(P=0.639),time of reaching the standard of vital signs(P=0.525),incidence of SIRS(P=0.489),incidence of MODS(P=0.298),invasive intervention(P=0.284),mechanical ventilation(P=0.645),mortality(P=1.000),rate of transferring to ICU(P=1.000),time of fasting and water deprivation(P=0.387),rate of transferring to sap 3 days after admission(P=0.213)and rate of entering ICU There was no significant difference in the incidence of conversion to sap 7 days after admission(P=0.678),P>0.05.Conclusion:For patients with acute pancreatitis not matching the criteria of SAP,implementation of high-speed FR can achieve the target time of fluid resuscitation earlier and shorten the time of fasting and water deprivation.Immediate FR in ER can reduce the incidence of multiple organ dysfunction,the total length of stay,the time of fasting and water deprivation,and reduce the transformation of severe acute pancreatitis than FR after hospitalization.