title: Effects of different resuscitation fluid on severe acute pancreatitis.
abstract: OBJECTIVE
  To compare effects of different resuscitation fluid on microcirculation, inflammation, intestinal barrier and clinical results in severe acute pancreatitis (SAP).
  
  
  METHODS
  One hundred and twenty patients with SAP were enrolled at the Pancreatic Disease Institute between January 2007 and March 2010. The patients were randomly treated with normal saline (NS group), combination of normal saline and hydroxyethyl starch (HES) (SH group), combination of normal saline, hydroxyethyl starch and glutamine (SHG group) in resuscitation. The ratio of normal saline to HES in the SH and SHG groups was 3:1. The glutamine (20% glutamine dipeptide, 100 mL/d) was supplemented into the resuscitation liquid in the SHG group. Complications and outcomes including respiratory and abdominal infection, sepsis, abdominal hemorrhage, intra-abdominal hypertension, abdominal compartment syndrome (ACS), renal failure, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), operation intervention, length of intensive care unit stay, length of hospital stay, and mortality at 60 d were compared. Moreover, blood oxygen saturation (SpO2), gastric intramucosal pH value (pHi), intra-abdominal pressure (IAP), inflammation cytokines, urine lactulose/mannitol (L/M) ratio, and serum endotoxin were investigated to evaluate the inflammatory reaction and gut barrier.
  
  
  RESULTS
  Compared to the NS group, patients in the SH and SHG groups accessed the endpoint more quickly (3.9 ± 0.23 d and 4.1 ± 0.21 d vs 5.8 ± 0.25 d, P < 0.05) with less fluid volume (67.26 ± 28.53 mL/kg/d, 61.79 ± 27.61 mL/kg per day vs 85.23 ± 21.27 mL/kg per day, P < 0.05). Compared to the NS group, incidence of renal dysfunction, ARDS, MODS and ACS in the SH and SHG groups was obviously lower. Furthermore, incidence of respiratory and abdominal infection was significantly decreased in the SH and SHG groups, while no significant difference in sepsis was seen. Moreover, less operation time was needed in the SH and SHG group than the NS group, but the difference was not significant. The mortality did not differ significantly among these groups. Blood SpO2 and gastric mucosal pHi in the SH and SHG groups increased more quickly than in the NS group, while IAP was significantly decreased in the SH and SHG group. Moreover, the serum tumor necrosis factor-α, interleukin-8 and C-reactive protein levels in the SH and SHG groups were obviously lower than in the NS group at each time point. Furthermore, urine L/M ratio and serum endotoxin were significantly lower in the SH group and further decreased in the SHG group.
  
  
  CONCLUSIONS
  Results indicated that combination of normal saline, HES and glutamine are more efficient in resuscitation of SAP by relieving inflammation and sustaining the intestinal barrier.
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.forename: Jun-Gang
authors.initials: JG
authors.lastname: Zhang
authors.forename: He-Shui
authors.initials: HS
authors.lastname: Wu
authors.forename: Jin
authors.initials: J
authors.lastname: Tao
authors.forename: Qi
authors.initials: Q
authors.lastname: Qin
authors.forename: Shi-Chang
authors.initials: SC
authors.lastname: Deng
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.forename: Kui
authors.initials: K
authors.lastname: Tian
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhu
authors.forename: Chun-You
authors.initials: CY
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D002196:Capillaries; D016207:Cytokines / Q000097:blood; D004731:Endotoxins / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy; D005973:Glutamine / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007249:Inflammation; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000187:drug effects; D007792:Lactulose / Q000652:urine; D008297:Male; D008353:Mannitol / Q000652:urine; D008833:Microcirculation; D008875:Middle Aged; D010195:Pancreatitis / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*; D012965:Sodium Chloride / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D016207:Cytokines; D004731:Endotoxins; D006895:Hydroxyethyl Starch Derivatives; D005973:Glutamine; D008353:Mannitol; D012965:Sodium Chloride; D007792:Lactulose
keywords: Capillary leakage syndrome; Inflammatory reaction; Intestinal barrier; Intra-abdominal hypertension; Microcirculation