Effect of early controlled fluid resuscitation combined with traditional Chinese medicine treatment on the prognosis of severe acute pancreatitis

Objective To investigate the effect of early controlled fluid resuscitation combined with traditional Chinese medicine ( TCM) treatment on the prognosis of severe acute pancreatitis ( SAP) . Methods A retrospective analysis was performed for the clinical data of 48 patients with SAP who were treated in our hospital from July 2013 to August 2016, and according to the treatment modality, the patients were divided into early controlled fluid resuscitation-TCM treatment group ( treatment group with 26 patients) and conventional fluid therapy group ( control group with 22 patients) . The two groups were observed in terms of total liquid volume within 72 hours of treatment, urine volume, intra-abdominal pressure ( IAP) , mean arterial pressure ( MAP) , central venous pressure ( CVP) , and changes in heart rate and biochemical parameters, and the incidence of gastrointestinal dysfunction and related complications was evaluated. The continuous data, such as SAP severity score, clinical indices within 72 hours after admission, biochemical parameters before and after treatment, gastrointestinal dysfunction score, and IAP after treatment, were expressed as mean ± SD ( x ± s) , and the t-test was used for comparison of such data.The chi-square test was used for comparison of incidence rates of complications. Results Within 72 hours of treatment, both groups achieved the early treatment requirements for hematocrit ( HCT) , and the treatment group had significantly lower HCT than the control group ( t = 2. 188, P = 0. 034) . Compared with the control group, the treatment group had a significantly lower total liquid volume ( t = 7. 342, P< 0. 001) and a significantly greater improvement in heart rate ( t = 6. 315, P < 0. 001) . After treatment, the treatment group had significantly greater improvements in biochemical parameters including alanine aminotransferase, aspartate aminotransferase, total bilirubin, C-reactive protein, AMY, lipopolysaccharide, blood urea nitrogen, and creatinine compared with the control group ( t = 3. 420, 2. 170, 2. 700, 3. 330, 6. 960, 12. 590, 2. 400, and 2. 740, P = 0. 001, 0. 035, 0. 010, 0. 002, 0, 0, 0. 020, and 0. 009) . Both groups had a significant change in gastrointestinal dysfunction score after treatment ( both P < 0. 05) , and the treatment group had a significantly lower gastrointestinal dysfunction score than the control group ( t = 8. 063, P < 0. 001) . There was a significant difference in IAP after treatment between the two groups ( t = 2. 200, P = 0. 033) . The treatment group had a lower incidence rate of complications ( abdominal compartment syndrome, acute renal failure, acute respiratory distress syndrome, and multiple organ dysfunction syndrome) than the control group ( 15. 38% vs 50%) , and 1 patient in the control group experienced multiple organ dysfunction syndrome. Conclusion In patients with SAP, early controlled fluid resuscitation combined with TCM treatment can significantly improve gastrointestinal dysfunction, reduce the incidence of complications, and improve the prognosis of such patients.