Effect of hydroxyethyl starch on early stage of abdominal pressure and inflammatory cytokines in severe acute pancreatitis patients with intra-abdominal hypertension

Objective To investigate the effect of hydroxyethyl starch (HES) 130/0.4 on intra-abdominal hypertension (IAH) and inflammatory cytokines in early stage of severe acute pancreatitis (SAP). Methods Clinical data of 55 case of SAP with IAH from Nov 2007 to Oct 2013 in Pancreas Surgery Department of Wuhan Union Hospital were analyzed retrospectively. All patients received conventional treatment without operation. According to the method of fluid resuscitation, patients were divided into treatment group (n=24) and control group (n=31). In treatment group, patients received ringer solution plus 6% HES 130/0.4 for fluid resuscitation, and patients in control group received only ringer solution for fluid resuscitation. The IAP level, APACHEⅡ score and serum inflammatory cytokine from day 1 to 8 were measured. Results The baseline data between the two groups were comparable. The IAP level was significantly lower in treatment group than that in control group from day 5 to day 8 [(10.2±2.9), (8.8±2.9), (7.9±2.5), (6.9±2.6)mmHg vs (11.9±2.7), (10.5±2.7), (9.5±2.4), (8.6±2.5)mmHg, 1 mmHg=0.133 kPa, respectively], and the difference between the two groups was statistically significant (P<0.05). There was no significant difference in APACHEⅡ score between the two groups, but the decline of APACHEⅡ score from baseline (△APACHEⅡ score) was more significant in treatment group (P<0.05). The serum IL-1 and IL-8 level in treatment group at day 8 was lower than that in control group [(15.1±13.7)μg/L vs (23.6±13.5)μg/L, (11.2±12.8)μg/L vs (23.8±27.9)μg/L, respectively], and the difference between the two groups was statistically significant (P<0.05). And the serum TNF-α level in treatment group at day 4 and day 8 was lower than that in control group [(31.9±12.1)μg/L vs (43.4±22.4)μg/L, (24.2±12.8)μg/L vs (35.1±15.3)μg/L], and the difference between the two groups was statistically significant (P<0.05). Conclusions Early fluid resuscitation with HES 130/0.4 and ringer solution relieves IAH, reduces APACHEⅡ score and down-regulates IL-1, IL-8 and TNF-α level. Key words: Pancreatitis, acute necrotizing; Abdominal cavity; Pressure; Hetastarch; Inflammatory cytokines