Balanced Solution Versus Normal Saline in Predicted Severe Acute Pancreatitis

作者：Ke Lu, Bo Ye, Mingfeng Huang, Tao Chen, Gordon S. Doig, Chao Li, Ying‐Jie Chen, Hongwei Zhang, Lijuan Zhao, Guobing Chen, Shumin Tu, Long Fu, Honghai Xia, Dongliang Yang, Bin Wu, Baohua Ye, Guoxiu Zhang, Mei Yang, Qiang Li, Xiaomei Chen, Xinting Pan, Wenjian Mao, James Buxbaum, Samir Jaber, Zhihui Tong, Yuxiu Liu, John A. Windsor, Rinaldo Bellomo, Weiqin Li · 发表于：Annals of Surgery · 年份：2024 · DOI：10.1097/sla.0000000000006319 · 被引用次数：15 · 研究领域：Pancreatitis Pathology and Treatment、Trauma, Hemostasis, Coagulopathy, Resuscitation、Electrolyte and hormonal disorders

OBJECTIVE: To compare the effect of balanced multielectrolyte solutions (BMESs) versus normal saline (NS) for intravenous fluid on chloride levels and clinical outcomes in patients with predicted severe acute pancreatitis (pSAP). BACKGROUND: Isotonic crystalloids are recommended for initial fluid therapy in acute pancreatitis, but whether the use of BMES in preference to NS confers clinical benefits is unknown. METHODS: In this multicenter, stepped-wedge, cluster-randomized trial, we enrolled patients with pSAP (acute physiology and chronic health evaluation II score ≥8 and C-reactive protein >150 mg/L) admitted within 72 hours of the advent of symptoms. The study sites were randomly assigned to staggered start dates for a one-way crossover from the NS phase (NS for intravenous fluid) to the BMES phase (sterofudin for intravenous fluid). The primary endpoint was the serum chloride concentration on trial day 3. Secondary endpoints included a composite of clinical and laboratory measures. RESULTS: Overall, 259 patients were enrolled from 11 sites to receive NS (n = 147) or BMES (n = 112). On trial day 3, the mean chloride level was significantly lower in patients who received BMES [101.8 mmol/L (SD: 4.8) vs 105.8 mmol/L (SD: 5.9), difference -4.3 mmol/L (95% CI: -5.6 to -3.0 mmol/L) ; P < 0.001]. For secondary endpoints, patients who received BMES had less systemic inflammatory response syndrome (19/112, 17.0% vs 43/147, 29.3%, P = 0.024) and increased organ failure-free days [...