Liquid and volemic disorders in patients with different forms of acute pancreatitis after initiation of infusion therapy
Background. The incidence of acute pancreatitis (AP) and the increasing severity of its course are increased throughout the world reaching 67–70 people per 100,000 population in Ukraine. The strategy of conservative management of a patient with AP in the early phase determines the importance of homeostatic restoration of liquid compartments, which provides systemic, organ and tissue circulation. The purpose of the study: to determine the degree of damage to liquid compartments in various forms of acute pancreatitis after initiation of infusion therapy. Materials and methods. The results of a cohort prospective observation conducted in 2015–2018 are presented. The basis of the retrospective analysis is the clinical data of 61 patients with diagnosed AP. Age of patients — 46.6 ± 9.8 years; among them — 25 (41 %) women and 36 (59 %) men; average body mass 77.8 ± 6.0 kg. Baseline α-amylase was elevated to 211 ± 36 U/l, urine diastase — up to 1024 ± 74 U/l. Formation of groups for analysis is performed after initiation of infusion therapy with balanced isotonic saline solutions; determination of AP course — after the end of treatment. Results. When patients were admitted to the intensive care unit, hypovolemia due to the plasma loss was dominated on the background of acute surgical dehydration degree II–III: Ht — 59 ± 4 %, heart rate — 118 ± 6 bpm,
total serum protein — 79.9 ± 6.1 g/l. Clinical response to the initial infusion was associated with the severity of the subsequent course of the disease in accordance with the etiological factor of AP: alimentary, hepatobiliary, and traumatic. Then, if AP was not complicated, the volume of intravenous resuscitation during the first day of treatment was 2591 ± 961 ml (33.1–36.2 ml/kg), on day 2 — decreased to 1958 ± 490 ml (25.5–27.8 ml/kg). During the first 12 hours of treatment, the diuresis reduced to 500 ml, increased to 0.8–
1.0 ml/kg/h only by the end of the second day against the background of fluid recovery. In severe and complicated course of AP, the initial volume of combined intravenous resuscitation was 3304 ± 310 ml during the first day of treatment (42.6–45.7 ml/kg),
on the second day, it reduced to 2384 ± 309 ml (24.3–28.7 ml/kg),
and did not decrease on day 3. The final and initial oliguria in these patients is greater than in the first 12 hours of treatment, the diuresis is reduced to 250 ml, its spontaneous recovery is delayed by 24–32 hours against the background of combined liquid resuscitation, which was initially carried out for at least 5 days in the intensive care unit. Conclusions. The response to the initial infusion is associated with the severity of the further course of the disease and the etiological factor of AP, depending on the degree of acute surgical dehydration due to the severity of damage to the pancreas. In the uncomplicated course of alimentary interstitial edematous pancreatitis, on the background of the initial infusion, there is a clinical improvement, early rehydration and remobilization of deposited liquid. In severe AP, despite the timely start of combined infusion therapy in the early phase, there are systemic fluid violations against the background of persistent organ failure of varying severity; due to the formation of sequestered fluid formations, no proper re-mobilization of the initially deposited liquid occur. In acute biliary pancreatitis, after the beginning of infusion therapy, visceral disorders dominate: signs of biliary hypertension mainly due to choledocholithiasis, cholestasis and inflammation of the biliary tract supporting secondary disorders in fluid compartments.
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