背景:由于重症急性胰腺炎(SAP)涉及由胰腺局部炎症产生的炎症介质,从而引发全身性炎症反应,需要强化液体管理以维持SAP发作早期的血流动力学.Goreisan被认为在水过量的状态下具有利尿作用,在脱水状态下具有抗利尿作用,调节两个方向的水平衡。我们研究了Goreisan对SAP患者水平衡的临床影响。患者和方法:将确诊为SAP72小时内入住ICU的SAP患者分为两组:Rikkunshito组(2015年10月之前)和Goreisan组(2015年11月之后)。累计输液量,尿液,通过CHF去除流体,鼻胃管引流,入住ICU的第1天至第5天的水平衡。
结果:纳入30例患者。中位年龄为57(40-69)岁,21/30(70%)为男性。日本急性胰腺炎标准的预后因子评分为5.5(3.3-7)。在30名患者中,14人在Rikkunshito组,16人属于Goreisan组.输液的累积体积没有差异,尿液,通过CHF去除流体,两组患者入住ICU第1天至第5天鼻胃管引流。然而,Rikkunshito组入院第1天至第5天的累积水平衡为4,957±6,091mL,而Goreisan组较低,为498±3,918mL(P=0.023)。
结论:我们的研究表明,重症急性胰腺炎患者服用Goreisan可能会改善发病早期的水平衡。在严重急性胰腺炎发作时早期服用Goreisan可以调节毛细血管和间质之间的液体运动,并减轻由于补充水引起的液体超负荷。
BACKGROUND: Since severe acute pancreatitis (SAP) involves inflammatory mediators produced by local inflammation of the pancreas that trigger a systemic inflammatory response, intensive fluid management is required to maintain hemodynamics in the early stages of the onset of SAP. Goreisan is considered to have a diuretic effect in a state of excess water and an antidiuretic effect in a state of dehydration, regulating water balance in both directions. We investigated the clinical effects of Goreisan on water balance in SAP patients. Patients and methods: SAP patients admitted to our ICU within 72 hours of being diagnosed with SAP were divided into two groups: the Rikkunshito group (before October 2015) and the Goreisan group (after November 2015). Cumulative volume of fluid infusion, urine, fluid removal by CHF, nasogastric tube drainage, and water balance from day 1 to day 5 of ICU admission.
RESULTS: Thirty patients were included. The median age was 57 (40-69) years, and 21/30 (70%) were male. The prognostic factor score in Japanese criteria for acute pancreatitis was 5.5 (3.3-7). Of the thirty patients, 14 were in the Rikkunshito group, and 16 were in the Goreisan group. There were no differences in the cumulative volume of fluid infusion, urine, fluid removal by CHF, or nasogastric tube drainage from day 1 to day 5 of ICU admission between the two groups. However, the cumulative water balance from day 1 to day 5 of admission was 4,957 ± 6,091 mL in the Rikkunshito group, whereas it was lower in the Goreisan group at 498 ± 3,918 mL (P = 0.023).
CONCLUSIONS: Our study showed that Goreisan administration in patients with severe acute pancreatitis might improve water balance in the early phase of onset. Early administration of Goreisan at the onset of severe acute pancreatitis may regulate fluid movement between capillaries and interstitium and alleviate fluid overload due to water refill.