关键词: 胰腺炎, 复苏, 补液疗法, 液体复苏, 临床转归, 预后

Abstract: Background　Fluid resuscitation is considered as the key of early treatment of acute pancreatitis（AP），but there are few reports about the fluid resuscitation scheme in patients initially assessed as non-severe AP，moreover，the impact of early active fluid resuscitation on the progression of non-severe AP to severe AP and prognosis is inconclusive. Objective　To investigate the impact of early active fluid resuscitation on patients initially assessed as non-severe AP. Methods　From 1 January to 31 December，2018，219 patients initially assessed as non-severe AP were selected from Department of Gastroenterology，the Third People's Hospital of Chengdu and divided into control group（n=118，using conventional treatment plus regular fluid resuscitation with fluid volume<3 200 ml administered within 24 hours of admission）and observation group（n=101，using conventional treatment plus active fluid resuscitation with fluid volume ≥3 200 ml administered within 24 hours of admission）. Total volume of fluid resuscitation at 24，48 and 72 hours after admission，clinical outcome，rate of reaching the improved criteria by fluid resuscitation as well as rate of progression to severe AP 3 and 7 days after treatment were compared between the two groups，and subgroup analysis was conducted. Results　Compared to control group，observation group had larger total volume of fluid resuscitation administered within 24 hours of admission，longer fasting time for solids and liquids，higher rate of reaching the improved criteria by fluid resuscitation and lower rate of progression to severe AP 3 and 7 days after treatment，as well as lower incidence of systemic inflammatory response syndrome（SIRS）（P<0.05）. Subgroup analysis indicated that，compared to the controls，mild patients in observation group had longer fasting time for solids and liquids，and higher incidence of SIRS（P<0.05）. In control group，longer fasting time for solids and liquids as well as hospital stays，higher rates of undergoing mechanical ventilation and invasive/interventional treatment，transferring to ICU and progression to severe AP 3 and 7 days after treatment were found in moderate patients compared to the mild patients（P<0.05）. In observation group，longer fasting time for solids and liquids，and higher rate of progression to severe AP 7 days after treatment were found in moderate patients compared to mild patients（P<0.05）. Conclusion　In patients initially assessed as non-severe acute pancreatitis，early active fluid resuscitation（total volume of fluid resuscitation administered within 24 hours of admission is suggested to be larger than half of that administered within 48 hours of admission or ≥3 200 ml）may be helpful to improve the clinical outcome，rate of reaching the improved criteria by fluid resuscitation，and reduce the risk of progression to severe AP，with no association with the degree of AP（mild or moderate）at diagnosis.

Key words: Pancreatitis, Resuscitation, Fluid therapy, Fluid resuscitation, Clinical outcome, Prognosis