Effect of continuous renal replacement therapy on respiratory function and cytokines in the treatment of severe acute pancreatitis complicated with acute respiratory distress syndrome / 中国基层医药

ABSTRACT

Objective To explore the effects of continuous renal replacement therapy (CRRT) on the changes of the respiration and blood circulation as well as peripheral blood cytokines levels in patients with severe acute pancreatitis(SAP) complicated with acute respiratory distress syndrome.Methods 48 SAP patients complicated with acute respiratory distress syndrome were divided into control group and CRRT treatment group according to the parallel control design principle.The control group was treated with routine way,and the CRRT treatment group was treated with CRRT on the basis of routine way.The clinical data and the levels of IL-6,IL-1β,TNF-α were compared between the two groups.Results The levels of IL-6,TNF-α were significantly lower in the CRRT treatment group than those in the control group in 12h [(147.72 ± 22.06) ng/L vs.(132.27 ± 18.03) ng/L,t =2.315,P＜0.05;(236.08 ±41.29) ng/L vs.(208.79±39.25)ng/L,t =2.406,P ＜0.05].The levels of IL-6,IL-1β,TNF-α were significantly lower in the CRRT treatment group than those in the control group in 24h [(136.57 ± 30.74) ng/L vs.(109.98 ± 35.83) ng/L,t =2.184,P ＜ 0.05;(35.76 ± 8.57) ng/L vs.(28.96 ±3,95) ng/L,t =2.237,P ＜0.05;(219.81 ±36.06) ng/L vs.(173.48 ±48.19) ng/L,t =2.206,P ＜0.05].The level of PaO2/FiO2 was significantly higher in the CRRT treatment group than that in the control group in 24h[(139.89 ±35,61) vs.(173.12 ±21.84),t =2.913,P ＜0.01].The levels of Ppeak,IL-1β were significantly lower in the CRRT treatment group than those in the control group in 48h [(28.96 ± 4.14) cmH2 O vs.(24.73 ± 8.52) cmH2 O,t =2.518,P ＜0.05;(29.87 ±5.12) ng/L vs.(23.57 ±3.91) ng/L,t =2.427,P ＜0.05].The levels of IL-6,TNF-αwere significantly lower in the CRRT treatment group than those in the control group in 48h [(117.60 ± 23.46) ng/L vs.(88.56 ± 13.02) ng/L,t =3.062,P ＜ 0.01;(205.25 ± 46.14) ng/L vs.(141.63 ± 33.80) ng/L,t =3.174,P ＜0.01].The level of PaO2/FiO2 was significantly higher in the CRRT treatment group than that in the control group in 48h [(148.07 ± 25.64) vs.(193.23 ± 29.60),t =2.983,P ＜ 0.01].There were no significant differences between the control group and CRRT treatment group in PaO2/FiO2,Ppeak,IL-6,IL-1β,TNF-α before treatment [(103.68±29.65) vs.(107.07 ±25.13),t =0.359,P ＞0.05;(34.62 ±7.36)cmH2O vs.(35.18 ±4.04)cmH2O,t =0.416,P ＞0.05;(152.61 ±31.53)ng/L vs (150.74 ±30.26) ng/L,t =0.668,P ＞0.05;(40.06 ±5.15) ng/L vs.(38.09 ±10.13) ng/L,t =0.819,P ＞0.05;(226.85 ±37.62) ng/L vs.(225.47 ±39.02) ng/L,t =0,702,P＞0.05].Conclusion CRRT can effectively reduce the plasma levels of IL-6,IL-1β,TNF-α in SAP patients complicated with acute respiratory distress syndrome,it has therapeutic effect on the respiration through changing the cytokines of SAP patients complicated with acute respiratory distress syndrome.