Effect of Different‐Volume Fluid Resuscitation on Organ Functions in Severe Acute Pancreatitis and Therapeutic Effect of Poria cocos

Abstract

Objective. To explore the effect of different-volume fluid resuscitation (FR) on organ functions in severe acute pancreatitis (SAP) and to elucidate the therapeutic effect and mechanism of Poria cocos on organ injuries caused by high-volume FR. Methods. 1. Clinical study: retrospective analysis of thirty-one patients about the effect of titrated fluid resuscitation protocol (TFR) on the occurrence of acute kidney injury (AKI) secondary to SAP. 2. Experimental study: rats (N = 30) were randomly divided into five groups: sham, model, low-volume FR (1.5 ml/kg/h), high-volume FR (10 ml/kg/h), and Poria cocos combined with high-volume FR (10 ml/kg/h + intraintestinal administration Poria cocos 5 g/kg); serum or plasma indicators and histopathologic scores were compared to explore the effect and mechanism of different fluid volumes and Poria cocos on organ function in SAP. Results. The occurrence of AKI, fluid volume, and fluid velocity in TFR group was lower than that in the control group. Logistic regression analysis showed that increased Marshall scores and fluid velocity were risk factors for predicting occurrence of AKI in SAP. Low-volume FR decreased the levels of blood urea nitrogen (BUN), serum creatinine (Cr), matrix metalloproteinase (MMP), and pathologic scores of the pancreas and kidney. High-volume FR increased ascites, MMPs, and kidney pathologic scores. Poria cocos decreased the levels of BUN, Cr, MMPs, and pathologic scores of the pancreas and kidney and increased the arterial oxygen saturation. Conclusion. TFR-associated lower fluid volume and velocity reduced the occurrence of AKI secondary to SAP. High volume might aggravate AKI via increased MMP release leading to endothelial glycocalyx damage and vascular endothelial dysfunction. Poria cocos reduced MMP release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. Therefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP.

Zengye Decoction Attenuated Severe Acute Pancreatitis Complicated with Acute Kidney Injury by Modulating the Gut Microbiome and Serum Amino Acid Metabolome

“…Sprague Dawley rats were randomly separated into the control group (C, N = 7) with sham operation, SAP model group (MG, N = 7), and ZYD treatment group (ZYD, N = 7). All rats were anesthetized with pentobarbital sodium solution (2%) by intraperitoneal injection (50 mg/kg) [ 23 ]. The subsequent operation is similar as Zhang et al described in their research [ 24 ].…”

Construction and alidation of a severity prediction model for acute pancreatitis based on CT severity index: A retrospective case-control study

“…Additionally, ascites contribute to elevated intra-abdominal pressure in SAP patients, and therapeutic paracentesis to reduce this pressure is an effective means of lowering mortality [25]. Research by Yi et al [26] found that aggressive fluid resuscitation increased ascites, a risk factor for predicting acute kidney injury in SAP. This study also indicates that the occurrence of ascites is closely related to the development of SAP, potentially leading to infections, increased intra-abdominal pressure, and other complications.…”