Abstract: 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 ±s and comparison between groups was analyzed using t test. Count data were analyzed using the chisquare 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, Creaction protein (CRP), Ddimer, 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, Ddimer 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 Ddimer 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)×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.