ABSTRACT
Objective To study the difference in outcomes between two treatment regimens of goal-directed fluid therapy in patients with severe acute pancreatitis. Methods From January 2000 to January 2010, 80 patients with severe acute pancreatitis were assigned into 2 groups. In group A,patients received fluid therapy aiming at the following goals in 24 hours: (1) Blood pressure >90/60 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1. In group B, patients received fluid therapy aiming at the following goals in 6 hours (according to SSC guideline,2004): (1) mean arterial blood pressure >65 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1 ;(4) central venous oxygen saturation >70%. After therapy for 3 days we measured the Marshall score, APACHE Ⅱ score, and the peri-pancreatic infection and mortality rates. Results The Marshall score was 6. 82±4. 69 and 4. 48±3. 78 in group A and B, respectively (P=0. 02). The APACHE Ⅱ score was 11. 35±5. 96 and 8. 22±4. 53 in group A and B, respectively (P=0. 01). The peri-pancreatic infection rate was 44% and 37% in group A and B, respectively, and there was no significant difference between the 2 groups (P = 0. 65). The mortality rate was 24% and 17% in group A and B. There was no significant difference between the 2 groups(P=0. 57). Conclusion Goal-directed fluid therapy in patients with severe acute pancreatitis according to the SSC guideline improved organ function but it did not reduce peri-pancreatic infection and mortality rates.
ABSTRACT
Objective To study the changes of vascular endothelial functional status and cytokine TNF-α in patients with multiple organ dysfunction syndrome (MODS).Methods Plasma levels of tissue plasminogen activator (t-Pa), plasminogen activator inhibitor-1 (PAI-1 ), circulating endothelial cell (CEC) and serum levels of endothelin (ET-1), tumor necrosis factor- ( (TNF-α), nitric oxide (NO) were determined serially dynamically in patients with MODS and those without MODS (non-MODS). At the same time Marshall scores were evaluated.Results Blood levels of TNF-α, ET-1, PAI-1, CEC, and Marshall scores were significantly higher in MODS and succumbed (those who died) groups than those in non-MODS and survied (those who lived) groups (P ＜ 0.05), but blood levels of NO and t-Pa were significantly lower ( P ＜ 0.05).Conclusion TNF-α played an important role in the progression of MODS. The increase of ET-1, PAI-1, CEC and the decrease of NO and t-Pa indicated endothelial dysfunction in MODS. Marshall scoring system for MODS was a sensitive parameter in evaluating the patients with MODS.