The impact of the initial fluid resuscitation with different ratio of crystalloid and colloid on the prognosis of patients with moderate severe acute pancreatitis

Objective To investigate the impact of the initial fluid resuscitation with different ratio of crystalloid and colloid on the prognosis of patients with moderate severe acute pancreatitis (MSAP). Methods A retrospective analysis was made by reviewing the clinical data of 72 patients with the diagnosis of MSAP from January 2015 to July 2017 in Shanghai Changhai Hospital. According to crystalloid-colloid ratio, which was the total volume of crystalloid fluid versus colloid fluid in the first 7d at admission, patients were randomly divided into low crystalloid-colloid ratio group ( 7.5). The parameters of the fluid resuscitation, the cases progressing into severe acute pancreatitis(SAP), the incidence of multiple organs dysfunction syndrome(MODS)and mechanical ventilation, pancreatic necrosis and infection rate, 30-day mortality, the duration of systemic inflammatory response syndrome(SIRS) and the time reaching full amount of enteral nutrition were analyzed. Results There was no statistically significant difference in gender, age, etiology and APACHEⅡ score within 24 h at admission in each group, which were comparable. Within the first 7 d, there were no statistic difference in the total volume of fluid infusion and the speed of resuscitation in the three groups. While the total fluid volume in the first 24 h and 72 h [(3 095±1 253)ml vs (2 524±751) ml, (8 005±7 269)ml vs (6 667±1 498)ml], the total volume of crystalloid fluid in the first 7 d [ (14 485±3 917) ml vs (11 544±2 639)ml], crystalloid-colloid ratio (12.7±4.9 vs 6.0±1.0), the cases of SAP (12 vs 4), MODS (41.7% vs 16.0%) in high ratio group were significantly higher than those in middle ratio group, but the total volume of colloid fluid was significantly lower [ (996±528)ml vs (1 968±574) ml]. In addition, the duration of SIRS [ (16.5±15.2)d vs (8.2±6.4)d], and the time reaching full amount of enteral nutrition [ (7.2±3.6)d vs (4.8±2.4)d] in high crystalloid-colloid ratio group were higher than those in middle crystalloid-colloid ratio group (all P<0.05). Comparing with middle crystalloid-colloid ratio group, there were no significant difference in the mechanical ventilation rate, pancreatic necrosis and infection rate and 30-day mortality in high ratio group. The total volume of colloid fluid was significantly higher [ (3 680±1 310) vs (1 968±574) ] and the crystalloid-colloid ratio was significantly lower [(3.2±0.9) vs (6.0±1.0)] in low ratio group than that in middle ratio group, and there were no statistical differences on other parameters. Conclusions For the patients with MSAP, early fluid resuscitation with the crystalloid-colloid ratio of (4.5-7.5) can decrease the incidence of SAP and MODS, shorten the duration of SIRS, and promote the recovery of intestinal mucosal barrier function. Key words: Pancreatitis, acute necrotizing; Fluid therapy; Crystalloid solutions; Colloidal solutions; Ratio; Prognosis