Abstract
Objective To explore the effect of different-volume fluid resuscitation (FR) on organ functions in severe acute pancreatitis (SAP) and to elucidate the therapeutic effect and mechanism of Poria cocos on organ injuries caused by high-volume FR. Methods 1. Clinical study: retrospective analysis of thirty-one patients about the effect of titrated fluid resuscitation protocol (TFR) on the occurrence of acute kidney injury (AKI) secondary to SAP. 2. Experimental study: rats (N = 30) were randomly divided into five groups: sham, model, low-volume FR (1.5 ml/kg/h), high-volume FR (10 ml/kg/h), and Poria cocos combined with high-volume FR (10 ml/kg/h + intraintestinal administration Poria cocos 5 g/kg); serum or plasma indicators and histopathologic scores were compared to explore the effect and mechanism of different fluid volumes and Poria cocos on organ function in SAP. Results The occurrence of AKI, fluid volume, and fluid velocity in TFR group was lower than that in the control group. Logistic regression analysis showed that increased Marshall scores and fluid velocity were risk factors for predicting occurrence of AKI in SAP. Low-volume FR decreased the levels of blood urea nitrogen (BUN), serum creatinine (Cr), matrix metalloproteinase (MMP), and pathologic scores of the pancreas and kidney. High-volume FR increased ascites, MMPs, and kidney pathologic scores. Poria cocos decreased the levels of BUN, Cr, MMPs, and pathologic scores of the pancreas and kidney and increased the arterial oxygen saturation. Conclusion TFR-associated lower fluid volume and velocity reduced the occurrence of AKI secondary to SAP. High volume might aggravate AKI via increased MMP release leading to endothelial glycocalyx damage and vascular endothelial dysfunction. Poria cocos reduced MMP release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. Therefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP.
Highlights
Acute pancreatitis (AP) is a common acute inflammatory disease in pancreas, and majority of this disease is mild and self-limited. e number of people attacked by AP goes up worldwide and 10%–20% of the mild cases progress to severe acute pancreatitis (SAP) with a mortality of 10% to 30% among those severe cases [1, 2]
Poria cocos reduced matrix metalloproteinase (MMP) release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. erefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP
No statistical difference in age, gender, etiology, body mass index, onset time, SIRS score, APACHEII score, Computed tomography (CT) scores, creatinine at admission, start-up, and duration of fluid resuscitation between two groups showed that the following differences were irrespective of baseline difference of two groups
Summary
Acute pancreatitis (AP) is a common acute inflammatory disease in pancreas, and majority of this disease is mild and self-limited. e number of people attacked by AP goes up worldwide and 10%–20% of the mild cases progress to severe acute pancreatitis (SAP) with a mortality of 10% to 30% among those severe cases [1, 2]. AP patients with persistent organ failure are diagnosed as SAP, and kidney is one of the most common organs involved [3]. Highvolume fluid resuscitation can rapidly restore the intravascular volume but involves positive cumulative fluid balance which may deteriorate respiratory and kidney injuries in AP [10, 11]. Goaldirected fluid therapy can decrease excessive positive fluid balance and mortality and benefit more to patients than high volume [12, 13]. Current guidelines recommend goal-directed fluid resuscitation in early phase management of SAP, but optimal protocol including topics of fluid volume, velocity and initial time is debated [14, 15]
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