急性胰腺炎患者早期液体复苏管理的最佳证据总结

Summary of optimal evidences for early fluid resuscitation management in patients with acute pancreatitis

目的系统检索、评价并整合国内外关于急性胰腺炎(AP)患者早期液体复苏管理的最佳证据,为临床决策提供参考。方法计算机检索BMJ Best Practice、Up To Date、JBI循证卫生保健中心、英国国家卫生与临床优化研究所、加拿大安大略注册护士协会、国际指南协作组、苏格兰学院间指南网、国际胰腺学会、美国胰腺学会、美国胃肠病学会、医脉通、Cochrane Library、PubMed、Embass、CINAHL、The Web of Science、中国知网、万方数据库中关于AP早期液体复苏管理的相关证据,检索时限为建库至2022年3月20日。文献类型包括专题证据汇总、指南、证据总结、系统评价、专家共识,由研究员对文献进行质量评价,并对符合标准的文献进行证据提取。结果共纳入13篇文献,包括专题证据汇总3篇、指南4篇、证据总结2篇、系统评价2篇、专家共识2篇,整合了16条最佳证据,涉及组织管理、评估与监测、补液策略、健康教育4个方面。结论建议应用目标导向疗法进行早期液体复苏管理,在确诊后即刻进行液体复苏,并根据患者基础疾病、病情变化及监测指标,精准实施早期液体复苏,以利于逆转胰腺微循环障碍,增加组织灌注,改善患者预后。

Objective To systematically retrieve,evaluate and integrate the best evidences on the early fluid resuscitation management in the patients with acute pancreatitis(AP)at home and abroad to provide reference for clinical decision.Methods The related evidences on the early fluid resuscitation management in the AP patients were retrieved by computer from the databases of BMJ Best Practice,Up To Date,JBI,National Institute for Health and Care Excellence,Registered Nurses Association of Ontario,Guideline International Network,Scottish Intercollegiate Guidelines Network,International Association of Pancreatology,American Pancreatic Association,American College of Gastroenterology,Yimaitong,Cochrane Library,PubMed,Embass,CINAHL,The Web of Science,CNKI,Wanfang databases.The retrieval time limit was from the database establishment to March 20,2022.The literatures types included thematic evidence summarization,guidelines,evidence summaries,systematic reviews and expert consensus.The researcher s conducted the literature quality evaluation.The literatures meeting the standard conducted the evidence extraction.Results A total of 13 articles were included,including 3 special subject evidence summary,4 guidelines,2 evidence summary,2 systematic evaluation and 2 expert consensus.A total of 16 pieces of best evidence were integrated,involving 4 aspects of organization management,evaluation and monitoring,fluid infusion strategy and health education.Conclusion It is recommended to use the target-oriented therapy for early fluid resuscitation management,and perform the fluid resuscitation immediately after diagnosis,according to the patient’s underlying disease,disease changes and monitoring indicators,implement precise early fluid resuscitation in order to reverse pancreatic microcirculation disorder,increase tissue perfusion and improve the patient’s prognosis.