用乳酸林格溶液进行量身定制的水化,用于后内镜逆行性胆血管细胞造影 胰腺炎预防:一项随机对照试验
Eunae Cho1, Seong-Hun Kim2, Chang Hwan Park1
1Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea.
The American journal of gastroenterology
|June 24, 2024
概括
量身定制的积极补水有效地预防ERCP后胰腺炎 (PEP),而不会增加并发症. 这一策略提供了一种安全而有效的方法,用于在内镜逆行胆血管细胞造影 (ERCP) 后管理水分.
科学领域:
- 胃肠病学 胃肠病学
- 临床试验 临床试验
- 医疗补水策略 医疗补水策略
背景情况:
- 在ERCP后的胰腺炎 (PEP) 是内镜逆向胆血管瘤造影 (ERCP) 的常见并发症.
- 使用乳酸林格溶液进行激烈的水分是PEP的已知的预防措施.
- 人们担心,标准的积极水化方案的流体量大,持续时间长.
研究的目的:
- 评估针对预防PEP的量身定制的积极水化 (TAH) 策略的有效性和安全性.
- 在接受ERCP的患者中,将TAH与标准定制水化 (TSH) 进行比较.
主要方法:
- 一个前性,多中心,双盲,随机试验,涉及344名接受ERCP的患者.
- 患者被分配给TSH (1.5毫升/公斤/小时) 或TAH (20毫升/公斤ERCP后玻尿酸,然后3毫升/公斤/小时).
- 根据血清氨基酶水平和ERCP后4-6小时的腹痛,调整了水分.
主要成果:
- 与TSH组 (9.4%) (P = 0.03) 相比,TAH组的PEP发病率明显较低 (3.5%).
- 两组之间没有观察到与PEP严重程度或与流体过载相关的并发症的显著差异.
- 与TSH组相比,TAH组中PEP的相对风险为0.37.
结论:
- 量身定制的积极水化 (TAH) 是预防PEP的安全有效方法.
- 根据患者的症状和ERCP后的生物标志物,TAH可以进行个性化的流体管理.
- 这种方法解决了人们对与传统的侵略性水化相关的过度流体量和持续时间的担忧.
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