Influence of fluid resuscitation on pancreatic microthrombosis in severe acute pancreatitis

AIM: To make evaluation on fluid resuscitation with either hypertonic saline (HS) or dextran 40 (Dx) on pancreatic microthrombi and dysfunction of microcirculation in rats with severe acute pancreatitis (SAP).METHODS: SD rats were allocated into 4 groups randomly,ie.SAP group,HS group,Dx group,which respectively received normal saline (NS,4 mL/kg),HS (4 mL/kg),Dx (4 mL/kg) for 2 h by the tail intravenous injection consecutively after being made as SAP animal models,and operate sham group (OS).12 h after the operation,all animals were blooded to assess the serum amylase levels,plasma D-dimer,von Willebrand factor and GMP-140 levels.The amount of ascites was measured and the samples of the pancreas were collected for pathologic examination under light microscopy as well as transmission electron microscope.The numbers of pancreatic microthrombi were also counted with microscopy.RESULTS: (1) 12 h later when the rats were sacrificed,the survival rate in SAP group was the lowest,significantly lower than that in the 2 fluid resuscitation groups (P<0.05).However,no significant difference was found between the latter 2 groups though the survival numbers.(2) The numbers of microthrombi in the pancreas and the histological scoring of pancreatic injury were significantly fewer in the 2 fluid resuscitation groups than those in SAP group (P<0.05) though no significant difference was revealed between the 2 treated groups.The amounts of ascites,serum amylase,plasma D-dimer,von Willebrand factor and GMP-140 showed significant improvement in HS or Dx group compared to those in SAP group(P<0.05,P<0.01).However,no significant difference was found between the 2 fluid resuscitation groups.CONCLUSION: Fluid resuscitation with HS or Dx,if applied at the early stage,increases survival rate with lessened histological injury,fewer microthrombi and improved coagulation parameters including D-dimer,von Willebrand factor and GMP-140.Either hypertonic saline (HS) or dextran 40 (Dx) demonstrates the same improvement in the relevant laboratory parameters in SAP.