Effect of initial fluid resuscitation with different ratios of crystalloid-colloid on prognosis of patients with severe acute pancreatitis

Objective To investigate the effect of fluid resuscitation with different ratios of crystalloid-colloid in early resuscitation stage on prognosis of patients with severe acute pancreatitis( SAP). Methods Clinical data of patients with SAP from Jan. 2008 to Dec. 2012 were collected prospectively. According to crystalloid-colloid ratio 1. 5 or 3. 0, which was the input volume of crystalloid fluid versus colloid fluid in the first 24 hours,patients were divided into low ratio group( crystalloid-colloid ratio 1. 5,n = 26),middle ratio group( crystalloid-colloid ratio 1. 5 ~ 3. 0,n = 30) and high ratio group( crystalloid-colloid ratio 3. 0,n = 38). Among the patients who had been successfully resuscitated,rate of mechanical ventilation,the oxygenation index,intra-abdominal pressure( IAP),and the amount of fluid retention in the third space within the first 24 hours,as well as the parameters of fluid resuscitation and the survival rate within 2 weeks were collected and analyzed. Results In the first 24 hours,the rate of mechanical ventilation in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group( both P 0. 05); the oxygenation index was significantly lower than that in the middle ratio group and the low ratio group( both P 0. 05); the IAP was significantly higher than that in the middle ratio group and the low ratio group( both P 0. 05); the amount of fluid retention( ml) in the third space was significantly higher than that in the middle ratio group and the low ratio group( both P 0. 05). There was no significant difference in above indexes between middle ratio group and low ratio group( all P 0. 05). In the first 24 hours,the volume of crystalloid( ml) in high ratio group was significantly larger than that in the middle ratio group and the low ratio group( both P 0. 05); and the volume of colloid( ml) in high ratio group and middle ratio group was significantly lower than that in the low ratio group( both P 0. 05); and the mean crystalloid-colloid rate in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group( both P 0. 05). The volume( ml) of infused fluid during the first 72 hours in the high ratio group was significantly higher than that in the middle and low ratio groups( both P 0. 05). The survival rate in the high ratio group( 36. 8%) was significantly lower than that in the middle ratio group( 86. 7%,P 0. 05) and the low ratio group( 61. 5%,P 0. 05). Conclusion A suitable crystalloid-colloid ratio should be considered in the early stage of resuscitation in patients with SAP,which would result in a decrease in the fluid retention in the third space as well as an improvement of survival rate in return. The middle ratio of crystalloid-colloid fluid resuscitation should be the optimal strategy.