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Objective To investigate the application value of limited liquid resuscitation combined with continuous renal replacement therapy (CRRT) in treatment of severe acute pancreatitis (SAP) companied with abdominal compartment syndrome (ACS).Methods The retrospective cohort study was adopted.The clinical data of 67 patients with SAP companied with ACS who were admitted to the Fuling Center Hospital of Chongqing from January 2005 to December 2014 were collected.Among 67 patients,33 receiving conventional liquid resuscitation between January 2005 and December 2010 were allocated into the control group and 34 receiving limited liquid resuscitation combined with CRRT between January 2011 and December 2014 were allocated into the observation group.Observation indicators included:(1) required fluid volume and time of negative fluid balance in the 2 groups;(2) changes of pathological and physiological indicators after treatment in the 2 groups;(3)outcomes and prognosis of patients in the 2 groups.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.Repeated measurement data were analyzed by repeated measures ANOVA.Results (1) Required fluid volume and time of negative fluid balance in the 2 groups:required fluid volumes at 6,24,48 and 72 hours after resuscitation were (2 449±339) mL,(4 820±757) mL,(9 428± 1 272) mL,(13 127± 1 565) mL in the control group and (2 360± 314) mL,(4 582±530) mL,(8 564± 970) mL,(11 470± 1 253) mL in the observation group,respectively,with a statistically significant difference in required fluid volume between the 2 groups (F=13.035,P＜0.05) and in required fluid volume at 48 and 72 hours between the 2 groups (t=3.132,4.794,P＜0.05).Time of negative fluid balance in the observation group and control group was (4.3± 1.7)days and (6.4 ±1.8)days,respectively,showing a statistically significant difference between the 2 groups (t =4.913,P＜0.05).(2) Changes of pathological and physiological indicators in the 2 groups after treatment:time factors:from 0 h to 168 h postoperatively,APACHE Ⅱ score,C-reaction protein (CRP),D-dimer,IAP,Bla and oxygenation index were changed from 20.9±4.1 to 13.9±2.6,from (167±39)mg/L to (55±17) mg/L,from (1 652±1 544) μg/L to (993±500)μg/L,from (23.4±3.4)cmH2O (1 cmH2O=0.098 kPa) to (21.4±2.9)cmH2O,from (4.6±1.6) mmol/L to (1.4±0.5)mmol/L,from (189±27) mmHg (1 mmHg =0.133 kPa) to (152±23)mmHg in the control group,and chaged from 21.5±5.1 to 11.0±2.8,from (168±36)mg/L to (44±19)mg/L,from (1 634±1 525) μg/L to (578±350) μg/L,from (23.2±2.5)cmH2O to (17.4±2.6)cmH2O,from (4.5±1.6)mmol/L to (0.8±0.3)mmol/L,from (188±26)mmHg to (196±25)mmHg in the observation group,respectively,showing gradual decreasing with time and statistically significant differences between the 2 groups (F =186.415,581.118,34.618,212.416,262.272,207.645,P＜0.05).Treatment factors:there were no significant differences in changing trends of APACHE Ⅱ score,D-dimer and Bla between the 2 groups (F=3.499,2.350,3.516,P＞0.05),and there were significant differences in changing trends of CRP,IAP and oxygenation index between the 2 groups (F=4.009,15.276,14.959,P＜0.05).Interaction effect between time factors and treatment factors:there were obviously interaction effects between time factors and treatment factors in APACHE Ⅱ score,CRP,IAP and oxygenation index (F=4.890,4.912,23.874,28.615,P＜0.05) and no interaction effects between time factors and treatment factors in D-dimer and Bla (F=2.803,1.920,P＞0.05).(3) Outcomes and prognosis of patients in the 2 groups:numbers of patients with surgery,local complications and infection and duration of hospital stay were 11,16,14,(46±17)days in the control group and 4,6,6,(36±14) days in the observation group,respectively,with statistically significant differences between the 2 groups (x2=4.484,7.221,4.910,t =2.433,P＜0.05).Mortality and hospital expenses were 24.2％ (8/33),(33± 18) x 104 yuan in the control group and 8.8％ (3/34),(27± 14)× 104 yuan in the observation group,respectively,with no statistically significant difference between the 2 groups (x2 =2.901,t =1.283,P＞ 0.05).Conclusion Limited liquid resuscitation combined with CRRT can effectively control IAP of patients with SAP companied with ACS and improve oxygenation index,meanwhile,it can also reduce number of patients with surgery,infection and local complications and duration of hospital stay.
RESUMO
Objective To investigate the application value of limited liquid resuscitation combined with continuous renal replacement therapy (CRRT) in treatment of severe acute pancreatitis (SAP) companied with abdominal compartment syndrome (ACS).Methods The retrospective cohort study was adopted.The clinical data of 67 patients with SAP companied with ACS who were admitted to the Fuling Center Hospital of Chongqing from January 2005 to December 2014 were collected.Among 67 patients,33 receiving conventional liquid resuscitation between January 2005 and December 2010 were allocated into the control group and 34 receiving limited liquid resuscitation combined with CRRT between January 2011 and December 2014 were allocated into the observation group.Observation indicators included:(1) required fluid volume and time of negative fluid balance in the 2 groups;(2) changes of pathological and physiological indicators after treatment in the 2 groups;(3)outcomes and prognosis of patients in the 2 groups.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.Repeated measurement data were analyzed by repeated measures ANOVA.Results (1) Required fluid volume and time of negative fluid balance in the 2 groups:required fluid volumes at 6,24,48 and 72 hours after resuscitation were (2 449±339) mL,(4 820±757) mL,(9 428± 1 272) mL,(13 127± 1 565) mL in the control group and (2 360± 314) mL,(4 582±530) mL,(8 564± 970) mL,(11 470± 1 253) mL in the observation group,respectively,with a statistically significant difference in required fluid volume between the 2 groups (F=13.035,P＜0.05) and in required fluid volume at 48 and 72 hours between the 2 groups (t=3.132,4.794,P＜0.05).Time of negative fluid balance in the observation group and control group was (4.3± 1.7)days and (6.4 ±1.8)days,respectively,showing a statistically significant difference between the 2 groups (t =4.913,P＜0.05).(2) Changes of pathological and physiological indicators in the 2 groups after treatment:time factors:from 0 h to 168 h postoperatively,APACHE Ⅱ score,C-reaction protein (CRP),D-dimer,IAP,Bla and oxygenation index were changed from 20.9±4.1 to 13.9±2.6,from (167±39)mg/L to (55±17) mg/L,from (1 652±1 544) μg/L to (993±500)μg/L,from (23.4±3.4)cmH2O (1 cmH2O=0.098 kPa) to (21.4±2.9)cmH2O,from (4.6±1.6) mmol/L to (1.4±0.5)mmol/L,from (189±27) mmHg (1 mmHg =0.133 kPa) to (152±23)mmHg in the control group,and chaged from 21.5±5.1 to 11.0±2.8,from (168±36)mg/L to (44±19)mg/L,from (1 634±1 525) μg/L to (578±350) μg/L,from (23.2±2.5)cmH2O to (17.4±2.6)cmH2O,from (4.5±1.6)mmol/L to (0.8±0.3)mmol/L,from (188±26)mmHg to (196±25)mmHg in the observation group,respectively,showing gradual decreasing with time and statistically significant differences between the 2 groups (F =186.415,581.118,34.618,212.416,262.272,207.645,P＜0.05).Treatment factors:there were no significant differences in changing trends of APACHE Ⅱ score,D-dimer and Bla between the 2 groups (F=3.499,2.350,3.516,P＞0.05),and there were significant differences in changing trends of CRP,IAP and oxygenation index between the 2 groups (F=4.009,15.276,14.959,P＜0.05).Interaction effect between time factors and treatment factors:there were obviously interaction effects between time factors and treatment factors in APACHE Ⅱ score,CRP,IAP and oxygenation index (F=4.890,4.912,23.874,28.615,P＜0.05) and no interaction effects between time factors and treatment factors in D-dimer and Bla (F=2.803,1.920,P＞0.05).(3) Outcomes and prognosis of patients in the 2 groups:numbers of patients with surgery,local complications and infection and duration of hospital stay were 11,16,14,(46±17)days in the control group and 4,6,6,(36±14) days in the observation group,respectively,with statistically significant differences between the 2 groups (x2=4.484,7.221,4.910,t =2.433,P＜0.05).Mortality and hospital expenses were 24.2％ (8/33),(33± 18) x 104 yuan in the control group and 8.8％ (3/34),(27± 14)× 104 yuan in the observation group,respectively,with no statistically significant difference between the 2 groups (x2 =2.901,t =1.283,P＞ 0.05).Conclusion Limited liquid resuscitation combined with CRRT can effectively control IAP of patients with SAP companied with ACS and improve oxygenation index,meanwhile,it can also reduce number of patients with surgery,infection and local complications and duration of hospital stay.
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Objective To investigate the effects of different means of liquid resuscitation on microcirculation in rats with hemorrhagic shock. Method A model of rats with hemorrhagic shock was established in 40 Wistar rats. The rats were randomly divided into 4 groups according on different means of liquid resuscitation, and killed 24 hours after the examination, group A: without liquid resuscitation; group B: low-molecular-weight-40; group C: 7.5% hypertonic saline,group D:low-molecular-weight-40 + hyperonic saline. As well as the microcirculation in kidney was observed using electron microscope. Results In group without resuscitation, the microcirculation in kidney damaged severely; While in group with hypertonic or low molecule dextran alone, there was harm with dif-ferent degrees, and the microcirculation in kidney was nearly perfect in group with both hypertonic and low molecule dextran alone. Conclusions Different means of liquid resuscitation may infect the microcirculation in kidney, which with both hypertonic and low molecule dextran can protect the microcirculation in kidney.
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Objective To study the early resuscitation with intravenous administration of liquor in uncontrolled hemorrhagic shock model by four-staged abdominal aorta injury in rats in order to settle the controversy over the issue of volume resuscitation.Method Forty Sprague-Dawley rats were canulated with catheters into the left ventricle,femoral artery and femoral vein,respectively.Animals were subjected to vaseular injury of infrarenal pierced with a 25G needle leading to uncontrolled hemorrhagic shock.After aorta injury,the models were processed into 4 stages:early injured stage,early rescue stage,delayed rescue stage and observation stage.The rescue with rapid infusion of 45 ml/kg lactated Ringer's solution in 15 minutes in the early stage and the followed rescue in the late stage;and(4)sham-rescued.The MAP,CVP,lactic acid and Hct were monitored.The volume of blood loss and the survival time of rats were recorded too.Results After aorta injury,The MAP dropped from 94.3 mmHg to 25.8 mmHg and rised quickly after early resuscitation with rapid infusion of liquor and then again fell soon,and CVP did likewise.Lactic acid was increased and reached 3-4 times of baseline at 4 h in all group except Sham-resuced group.The Hct levels decreased quickly after resuscitation with liquor in early rescue stage and delayed rescue stage.The blood loss in abdomen increased after rapid infusion of lactated Ringer's solution in early rescue stage(blood loss increased from 22.8 ml/kg to 27.7ml/kg,P＜0.05).There Was no significant difference in mortality between those groups.Conclusions Rapid volume resuscitation at early stage of abdominal aorta injured with uncontrolled hemorrhagic shock cannot increase the circulatory blood volume for maintaining stable blood pressure norminimize the elevation of blood lactic acid.On the contrary,resuscitation with rapid administration of liquor at early stage can enhance blood loss and decrease the level of Hct.The survival time and survival rate can't be increased by early rescue with rapid liquor infusion.
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Objective To establish an abdominal-trauma-induced uncontrolled hemorrhagic shock (UHS) model, and explore the effect of staged resuscitation. Methods Indwelling catheters were inserted into left ventricle, femoral artery and femoral vein of 50 Sprague-Dawley rats, and then laparotomy was performed. 42 out of the 50 animals were subjected to vascular injury to simulate UHS by infra-renal arterial puncture with 25G needles, and the model was successfully established in 32 rats, for which the animals were divided into 3 groups: control group (n=10), with no resuscitation; hospital-resuscitation group (n=11), resuscitated in early injured stage; and staged-resuscitation group (n=11), resuscitated pre-hospital and then in-hospital. 8 out of the 50 rats, which were not subjected to vascular injury, served as sham-operated group. The mean aortic pressure (MAP), central venous pressure (CVP), serum lactic acid, alanine aminotransferase (ALT) and creatinine (Cr) were determined, and the volume of blood loss and survival time were recorded. Results The MAP decreased from 94.7mmHg to 28.9mmHg 15min after aortic injury in control group and rose slowly after continuous transfusion in staged-resuscitation group. Similar change was found in CVP. Serum lactic acid, ALT and Cr were increased in control group and hospital-resuscitation group at early injured stage, but the increase was delayed in staged-resuscitation group. The mean survival time in control group, hospital-resuscitation group and staged-resuscitation group were 76, 846 and 2480 min, respectively. The 72 h mortalities of the three groups were 100%, 72.7% and 36.4%, respectively. Conclusion Staged resuscitation which is characterized by slowly continuous transfusion at early aid stage cannot increase the blood pressure and circulating blood volume to normal level in UHS, but can reduce the level of serum lactic acid, ALT and Cr, and dose not increase the blood loss. The survival rate and mean survival time can be increased by this method.