ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.
Objective To evaluate the effectiveness of fluid therapy on an early goal-directed approach to resuscitation basis and the standard fluid therapy of adequate resuscitation on the prognosis of severe acute pancreatitis （SAP）in early stage. Methods The clinical data of SAP patients admitted to surgical intensive care unit within 72 h after onset of symptoms from January 2000 to November 2011 were analyzed retrospectively. A total of 97 patients with a confirmed diagnosis of SAP were divided into two groups based on whether adopting the early goal-directed fluid resuscitation strategies or not. Patients admitted from January 2000 to December 2004 did not adopt the early goal-directed fluid resuscitation strategies，therefore，being allocated into standard fluid therapy group （n=34）； patients admitted from January 2005 to November 2011 adopted the early goal-directed fluid resuscitation strategies and who were allocated into early goal-directed fluid therapy group （n=63）. With the exception of the fluid therapy strategies，the two group patients received standard treatment for SAP. The acute physiology and chronic health evaluation Ⅱ score （APACHEⅡ） and multiple organ dysfunction score （Marshall）， rate of multiple organ dysfunction syndrome （MODS） within the first week after admission，pancreatic infection rate，and in-hospital mortality were compared between the two groups. Results Compared with the standard fluid therapy group on day 3 after admission，APACHEⅡ score and Marshall score decreased significantly in the early goal-directed fluid therapy group （APACHEⅡ score：7.38±4.01 versus 11.35±4.27， P=0.011；Marshall score：4.13±2.06 versus 6.82±3.15， P=0.016）. In addition，patients in the early goal-directed fluid therapy group experienced a trend toward lower rates of MODS with the first week after admission，pancreatic infection，and in-hospital mortality （rate of MODS：46.0% versus 61.8%，P=0.139；rate of pancreatic infection：31.7% versus 44.1%， P=0.226；in-hospital mortality：15.8% versus 23.5%，P=0.355） that did not reach statistical significance. Conclusion Although early goal-directed fluid therapy for SAP in acute response stage may have ameliorated the patient’s condition and improved outcome to a certain degree，carefully designed human clinical trials should be performed in a randomized controlled manner to assess the role of such fluid resuscitation in SAP.