title: [Effects of early goal-directed fluid therapy on intra-abdominal hypertension and multiple organ dysfunction in patients with severe acute pancreatitis.].
abstract: OBJECTIVE
  To observe the effects of early goal-directed fluid therapy with hydroxyethyl starch 130/0.4 on intra-abdominal hypertension (IAH), multiple organ dysfunction and fluid balance in severe acute pancreatitis (SAP) patients.
  
  
  METHODS
  According to the criteria of selection and exclusion, 120 SAP patients within 72 hours after the symptom occurred from 4 study sites were recruited. They were given standard medication according to "the guideline of diagnosis and treatment of SAP in China" in SICU or PICU. The patients were randomly divided into two groups with crystalloid (control group) and colloid plus crystalloid resuscitation (research group). The objective of fluid therapy was to keep steady hemodynamics for 8 days. IAP was measured three times daily by means of urinary bladder transduction. Function of liver, renal and lung were detected daily. APACHE II score and fluid balance were calculated daily.
  
  
  RESULTS
  Total 120 cases were recruited into research group (n = 59) and control group (n = 61). The demography and baseline data were comparable. IAP was lower in research group than that in control group at day 4 and day 5 (P < 0.05). There was no significant difference in APACHE II scores between two groups pre- and after admission. The decline of daily IAP to baseline (DeltaIAP) in research group was significantly higher than in research group from day 2 to day 8(P < 0.05), whilst the decline of daily APACHE II score to baseline (DeltaAPACHE II score) in research group were significantly higher from day 4 to day 8 (P < 0.05). Negative fluid balance emerged much earlier in the research group (P = 0.036). Percentage of patients with negative fluid balance within 8 days was significantly higher in research group than that in control group (94.9% vs. 62.3%). The amount of positive fluid balance was significantly lower in research group (P = 0.039). IAP correlated significantly with APACHE II score (r(2) = 0.322, P = 0.000). PaO2/FiO2 was significantly higer in research group at day 4 and day 8.
  
  
  CONCLUSIONS
  It is very important to pay close attention to IAP in early fluid therapy of SAP patients. Early goal-directed fluid therapy with HES130/0.4 shortens the duration of positive fluid balance, decreases the amount of positive fluid balance, reduces APACHE II score, relieves IAH, and improves PaO2/FiO2.
authors.affiliation: Pancreatic Surgery, Union Hospital, Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Yang
authors.forename: Chun-You
authors.initials: CY
authors.lastname: Wang
authors.forename: Hong-Chi
authors.initials: HC
authors.lastname: Jiang
authors.forename: Bei
authors.initials: B
authors.lastname: Sun
authors.forename: Zhao-da
authors.initials: ZD
authors.lastname: Zhang
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Jin-Rui
authors.initials: JR
authors.lastname: Ou
authors.forename: Bao-Hua
authors.initials: BH
authors.lastname: Hou
mesh_terms: D005440:Fluid Therapy; D006040:Goals; D006801:Humans; D059325:Intra-Abdominal Hypertension; D009102:Multiple Organ Failure; D010195:Pancreatitis