A study on anti-inflammatory effect and opportunity of early blood purification for treatment of patients with severe acute pancreatitis / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.