Crit Care:急性胰腺炎积极和非积极静脉水合治疗的临床结局比较

2023-03-27 MedSci原创 MedSci原创 发表于上海

积极的静脉补水增加了严重AP的死亡风险,以及严重和非严重AP的液体相关并发症风险。建议对AP采取更保守的静脉液体复苏方案。

急性胰腺炎(AP)是世界范围内最常见、最严重的消化道疾病之一。据估计,全球急性胰腺炎的发病率和死亡率分别为34例每10万人每年和1.6例每10万人每年。据报道,近年来AP发病率不断上升。对AP适当的初始治疗决策可以显著影响病程和住院时间。目前,AP患者早期静脉水化期间最佳输液速率的实践指南仍然不一致。

近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,该系统综述和荟萃分析旨在比较积极和非积极静脉水化治疗严重和非严重AP的治疗结局。

该研究遵循了系统评价和Meta分析的首选报告项目指南。研究人员于2022年11月23日系统地检索了PubMed、Embase和Cochrane图书馆的随机对照试验(RCT),并手工检索纳入的RCT参考文献列表、相关综述文章和临床指南。研究人员纳入了比较积极和非积极静脉水合治疗AP临床结局的随机对照试验。研究人员采用随机效应模型对严重AP和非严重AP患者进行Meta分析。研究人员的主要结局是全因死亡率,几个次要结局包括48小时内液体相关并发症、临床改善和APACHEII评分。

研究人员共纳入了9项RCT,953名参与者。荟萃分析表明,与非积极静脉补水相比,积极静脉补水显著增加了严重AP的死亡风险(合并RR为2.45,95%CI为1.37,4.40),而非严重AP的结果不确定(合并RR为2.26,95%CI为0.54,9.44)。然而,积极的静脉水合治疗显著增加了严重AP(合并RR为2.22,95%CI为1.36,3.63)和非严重AP(合并RR:3.25,95%CI为1.53,6.93)液体相关并发症的风险。荟萃分析显示,严重AP的APACHEII评分更差(合并平均差值为3.31,95%CI为1.79,4.84),非严重AP的临床改善可能性没有增加(合并RR为1.20,95%CI为0.63,2.29)。在初始液体复苏治疗后,仅纳入目标导向液体治疗的随机对照试验的敏感性分析得出了一致的结果。

由此可见,积极的静脉补水增加了严重AP的死亡风险,以及严重和非严重AP的液体相关并发症风险。建议对AP采取更保守的静脉液体复苏方案。

原始出处:

Xiu-Wei Li,et al.Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis.Critical Care.2023.https://ccforum.biomedcentral.com/articles/10.1186/s13054-023-04401-0

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    2023-05-26 1249dc73m95暂无昵称 来自重庆

    这和之前的认知不一样

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2139152, encodeId=7fc92139152b7, content=这和之前的认知不一样, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba1e2501620, createdName=1249dc73m95暂无昵称, createdTime=Fri May 26 12:51:12 CST 2023, time=2023-05-26, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2138006, encodeId=b450213800658, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94fa8692515, createdName=ms2000002094261984, createdTime=Sat May 20 12:38:07 CST 2023, time=2023-05-20, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2121997, encodeId=7557212199e0c, content=急性胰腺炎, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d3d3015017, createdName=jshbyywk2008, createdTime=Mon Mar 27 06:20:25 CST 2023, time=2023-03-27, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2122000, encodeId=8f6921220009c, content=学习,打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2716443372, createdName=ms300, createdTime=Mon Mar 27 06:32:37 CST 2023, time=2023-03-27, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2122003, encodeId=11c02122003fb, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Mon Mar 27 07:15:36 CST 2023, time=2023-03-27, status=1, ipAttribution=)]
    2023-05-20 ms2000002094261984 来自河北省

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2139152, encodeId=7fc92139152b7, content=这和之前的认知不一样, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ba1e2501620, createdName=1249dc73m95暂无昵称, createdTime=Fri May 26 12:51:12 CST 2023, time=2023-05-26, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2138006, encodeId=b450213800658, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=94fa8692515, createdName=ms2000002094261984, createdTime=Sat May 20 12:38:07 CST 2023, time=2023-05-20, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2121997, encodeId=7557212199e0c, content=急性胰腺炎, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d3d3015017, createdName=jshbyywk2008, createdTime=Mon Mar 27 06:20:25 CST 2023, time=2023-03-27, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=2122000, encodeId=8f6921220009c, content=学习,打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2716443372, createdName=ms300, createdTime=Mon Mar 27 06:32:37 CST 2023, time=2023-03-27, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2122003, encodeId=11c02122003fb, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Mon Mar 27 07:15:36 CST 2023, time=2023-03-27, status=1, ipAttribution=)]
    2023-03-27 jshbyywk2008 来自河北省

    急性胰腺炎

    0

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    2023-03-27 ms300 来自吉林省

    学习,打卡

    0

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    2023-03-27 1212ad1cm87暂无昵称

    不错,学习了。

    0

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