[The impact of initial fluid resuscitation with different ratio of crystalloid-colloid on prognosis of patients with severe acute pancreatitis].

Objective To investigate the impact of fluid resuscitation with different ratio of crystalloid-colloid in early resuscitation stage on prognosis of patients with severe acute pancreatitis (SAP).Methods A retrospective analysis was made by reviewing clinical data of 47 patients with SAP fiom January 2001 to December 2011.According to crystalloid-colloid ratio 1.5 or 3,which was the input volume of crystalloid fluid versus colloid fluid in the first 24 hours,patients were divided into low ratio group (crystalloid-colloid ratio ＜1.5,n =13),middle ratio group (crystalloid-colloid ratio 1.5-3,n=15) and high ratio group (crystalloid-colloid ratio ＞3,n=19).Among the patients who had been successfully resuscitated,rate of mechanical ventilation,the oxygenation index,intra-abdominal pressure (IAP),and the amount of fluid retention in the third space within the first 24 hours,as well as the parameters of fluid resuscitation and the survival rate within 2 weeks were collected and analyzed.Results ① In the first 24 hours,the rate of mechanical ventilation in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group (68.4％ vs.20.0％,23.1％,both P＜0.05); the oxygenation index (mm Hg,1 mm Hg=0.133 kPa) was significantly lower than that in the middle ratio group and in the low ratio group (180.7 ± 26.3 vs.280.6 ± 24.8,260.3 ± 25.7,both P＜0.05) ; the IAP (cm H2O,1 cm H2O=0.098 kPa) was significantly higher than that in the middle ratio group and the low ratio group (16.8 ± 3.6 vs.13.4 ± 3.5,13.1 ±± 3.3,both P＜0.05) ; the amount of fluid retention (ml) in the third space was significant higher than that in the middle ratio group and the low ratio group (2834 ± 631 vs.1887 ± 282,1865 ± 300,both P＜0.05).There was no significant difference in above indexes between middle ratio group and low ratio group (all P＞0.05).② In the first 24 hours,the volume of crystalloid (ml) in high ratio group was significantly larger than that in the middle ratio group and the low ratio group (3611 ± 798 vs.2308 ±416,2124 ± 477,both P＜0.05); and the volume of colloid (ml) in high ratio group and middle ratio group was significantly lower than that in the low ratio group (993 ± 233,948 ± 140 vs.1506 ± 332,both P＜0.05) ; and the mean crystalloid-colloid rate in the high ratio group was significantly higher than that in the middle ratio group and the low ratio group (3.65±0.13 vs.2.43±0.13,1.41±0.08,both P＜0.05).Thevolume (ml) of infused fluid during the first 72 hours in the high ratio group was significantly higher than that in the middle and low ratio groups (11 941 ± 1161 vs.9036 ± 982,9400 ± 1051,both P＜0.05).③ The survival rate in the high ratio group (36.8％) was significantly lower than that in the middle ratio group (86.7％,P＜0.05) and the low ratio group (61.5％,P＞0.05).Conclusions A suitable crystalloid-colloid ratio should be considered in the early stage of resuscitation in patients with severe acute pancreatitis,which would result in a decrease in the fluid retention in the third space as well as an improvement of survival rate in return.It is suggested that the middle ratio of crystalloid-colloid fluid resuscitation should be the optimal strategy. Key words: Severe acute pancreatitis;  Fluid resuscitation;  Crystalloid-colloid ratio;  Survival rate