乳酸钠林格液和生理盐水治疗急性胰腺炎的荟萃分析  

Meta-analysis of lactated Ringer’s solution and normal saline for management of acute pancreatitis

作　　者：谷优优[1] 王珏磊[2] 陈宗南 王肃[1] 刘晓智[4] You-You Gu;Jue-Lei Wang;Zong-Nan Chen;Su Wang;Xiao-Zhi Liu(Department of Endocrinology,The Fifth Central Hospital of Tianjin,Tianjin 300450,China;Department of Gastroenterology,The Fifth Central Hospital of Tianjin,Tianjin 300450,China;Department of General Surgery,The Fifth Central Hospital of Tianjin,Tianjin 300450,China;Department of Central Laboratory,The Fifth Central Hospital of Tianjin,Tianjin Key Laboratory of Organ Development Epigenetics for Premature Infants,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院内分泌科,天津市300450 [2]天津市第五中心医院消化科,天津市300450 [3]天津市第五中心医院普外科,天津市300450 [4]天津市第五中心医院中心实验室,天津市早产儿器官发育表观遗传重点实验室,天津市300450

出　　处：《世界华人消化杂志》2021年第22期1292-1297,共6页World Chinese Journal of Digestology

基　　金：天津市自然科学基金资助项目,No.19JCZDJC35200;国家自然科学基金资助项目,No.81471175.

摘　　要：背景液体复苏是急性胰腺炎治疗的最重要的措施之一,生理盐水及乳酸钠林格液是临床常用晶体液.生理盐水价格便宜、易储藏,且应用经验丰富.乳酸钠林格液化学成分更接近于细胞外液,能有效补充机体的水份和电解质,减轻机体损伤,并可以减少肾脏替代治疗.近年来有多项研究结果发现,应用乳酸钠林格液或生理盐水进行液体复苏的的优越性尚存在一定争议.目的比较乳酸钠林格液和生理盐水治疗急性胰腺炎的疗效.方法计算机检索维普、中国知网、万方、Web of Science、PubMed数据库,检索时限截止至2020-12.进行资料提取后,采用RevMan 5.4软件进行统计分析.结果最终共纳入文献5篇,包括乳酸钠林格液组162例,生理盐水组189例.分析结果显示,乳酸钠林格液组的ICU住院率显著小于生理盐水组(OR=0.33,95%CI:0.13-0.81,P=0.02);而在住院天数(MD=-0.59,95%CI:-1.26-0.08,P=0.08)、死亡率(OR=1.39,95%CI:0.44-4.40,P=0.57)、24 h内出现全身炎症反应综合症(OR=0.73,95%CI:0.41-2.33,P=0.28)及胰腺坏死(OR=0.71,95%CI:0.35-1.45,P=0.35)方面,两组无统计学差异.结论与生理盐水相比,在急性胰腺炎时应用乳酸钠林格液进行液体复苏可减少ICU住院率;但乳酸钠林格液治疗急性胰腺炎在住院天数、死亡率、24小时内出现全身炎症反应综合症及胰腺坏死方面与生理盐水无明显差别.BACKGROUND Fluid resuscitation is one of the most important measures in the treatment of acute pancreatitis,and normal saline and lactated Ringer’s solution are commonly used in clinic.Normal saline is cheap and easy to store,and has wide application.Lactated Ringer’s solution is more like extracellular fluid,which can effectively replenish the body’s water and electrolytes,reduce body damage,and reduce kidney replacement therapy.In recent years,a number of studies have found that the advantages of using lactated Ringer’s solution or normal saline for fluid resuscitation are still controversial.AIM To compare the therapeutic efficacy of lactated Ringer’s solution and normal saline for the management of acute pancreatitis.METHODS The databases of Weipu,CNKI,Wanfang,Web of Science,and PubMed were searched by computer,and the search time was up to December 2020.After data extraction,RevMan 5.4 software was used for statistical analyses.RESULTS A total of five studies were included,including 162 cases who used lactated Ringer’s solution and 189 cases who used normal saline.Meta-analysis showed that compared with the normal saline group,the lactated Ringer’s solution group had a lower ICU admission rate(odds ratio[OR]=0.33,95%confidence interval[CI]:0.13-0.81,P=0.02);however,there was no significant difference in length of stay(mean difference[MD]=-0.59,95%CI:-1.26-0.08,P=0.08),mortality(OR=1.39,95%CI:0.44-4.40,P=0.57),systemic inflammatory response syndrome at 24 h(OR=0.73,95%CI:0.41-2.33,P=0.28),or pancreatic necrosis(OR=0.71,95%CI:0.35-1.45,P=0.35)between the two groups.CONCLUSION Liquid resuscitation with lactated Ringer’s solution can reduce ICU admission rate for patients with acute pancreatitis compared with normal saline.However,there are no significant differences in length of stay,mortality,systemic inflammatory response syndrome at 24 h,or pancreatic necrosis after treatment with lactated Ringer’s solution compared with normal saline.

关 键 词：乳酸钠林格液 生理盐水 急性胰腺炎 

分 类 号：R576[医药卫生—消化系统]