Clinical Study of Early Repeated Intermittent Veno-Venous Hemofiltration in Treatment of Severe Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Xinmin ¹ , LIU Mu ² , LI Yuntao ¹ , HUANG Dequan ¹ , CAO Yang ¹ , CHENG Jinchuan ¹ , HUANG Jiangtao ¹ , YU Lan ¹ , PENG Qiusheng ¹ , GONG Rong ¹

1. Department of General Surgery, 　The Third People’s Hospital of Chengdu City, Chengdu 610031,　China;;
　 2.　Department of Nephrology, The Second People’s Hospital of Yibin City of Sichuan Province, Yibin 644000,　China;

Corresponding author：

Keywords：

Severe acute pancreatitis; 　　Repeated intermittent veno-venous hemofilt ration; 　　Randomized clinical t rial

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the efficacy and mechanism of early repeated intermittent veno-venous hemofiltration (RIVVH) in treatment of severe acute pancreatitis (SAP). Methods Sixty-five patients were randomly divided into RIVVH group (35 cases) and control group (30 cases). Symptoms, physical signs, serum concentration of BUN, Cr, AST, ALT, AMS were observed and compared between two groups. The changes of C-reactive protein (CRP) and result of bacteria culture, APACHEⅡ grades and Balthazar CT grades, open-belly surgery rate, complications, mortality rate, average hospital stay and costs were compared between these two groups. Results Two patients died of multiple organ failure in the RIVVH group, with 5.7% mortality rate, which was significantly lower than that in the control group (26.7%, 8/30), P＜0.05. Twenty-four hours after treatment, symptoms and signs were alleviated more in RIVVH group; blood biochemical indicator, oxygenation index and CRP level improved significantly in RIVVH group compared with those in control group （P＜0.05，P＜0.01）. Balthazar CT grades and APACHEⅡ grades decreased significantly after treatment in patients of RIVVH group （P=0.002, P＜0.001）. The hospital stay, costs, open-belly surgery rate, complications rate and infection rate were also significantly lower in RIVVH group comparing with those in control group （P＜0.05, P＜0.001）. Conclusion RIVVH can decrease the mortality rate of SAP with high recovery rate, less cost and shorter hospital stay.

Citation： YAO Xinmin,LIU Mu,LI Yuntao,HUANG Dequan,CAO Yang,CHENG Jinchuan,HUANG Jiangtao,YU Lan,PENG Qiusheng,GONG Rong. Clinical Study of Early Repeated Intermittent Veno-Venous Hemofiltration in Treatment of Severe Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(5): 352-357. doi: Copy

1.	Chaing DT, Anozie A, Fleming WR , et al. Comparative study on acute pancreatitis management [Ｊ]. ANZ J Surg, 2004； 74(4)∶218.
2.	余文，吴伟，张少辉，等. 急性胰腺炎发病机理的研究进展 [Ｊ]. 中国普外基础与临床杂志， 2006； 13(6)∶733.
3.	中华医学会外科学分会胰腺外科学组. 重症急性胰腺炎诊治草案 [Ｊ]. 中国实用外科杂志, 2001； 21(9)∶513.
4.	孙诚谊，左石. 重症急性胰腺炎治疗中抗生素的合理应用 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)∶383.
5.	Knaus WA, Draper EA, Wagner DP, et al. APACHEⅡ: a severity of disease classification system [Ｊ]. Crit Care Med, 1985； 13(10)∶818.
6.	Balthazar EJ, Robison DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis [Ｊ]. Radiology, 1990； 174(2)∶331.
7.	Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [Ｊ]. JAMA, 1994； 271(3)∶226.
8.	Norman J. The role of cytokines in the pathogenesis of acute pancreatitis [Ｊ]. Am J Surg, 1998； 175(1)∶76.
9.	毛恩强，汤耀卿，张圣道. 进一步改善重症急性胰腺炎预后的探讨 [Ｊ]. 中国实用外科杂志, 2003； 23(1)∶50.
10.	陶京，王春友, 杨智勇, 等. 血液滤过治疗重症急性胰腺炎患者血浆炎性细胞因子水平的影响 [Ｊ]. 中华普通外科杂志， 2004； 19(4)∶233.
11.	李金林，曹权. CVVH对重症急性胰腺炎器官损害保护的临床观察 [Ｊ]. 实用全科医学， 2006； 4(4)∶393.
12.	郑邦瑞，沈文律，文军，等. 丹参注射液对重症急性胰腺炎大鼠胰腺NF-κB活化的影响 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)∶392.
13.	Zingarelli B, Sheehan M, Wong HR, et al. Nuclear factor-kappaB as a therapeutic target in critical care medicine [Ｊ]. Crit Care Med, 2003； 31(1 Suppl)∶ S105.
14.	Curley PJ. Endotoxin, cellular immunce dysfunction and acutu pancreatitis [Ｊ]. Ann R Coll Surg Engl, 1996； 78(6)∶531.
15.	Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observation in 100 consecutive episodes of DKA [Ｊ]. Am J Gastoenterol, 2000； 95(10)∶2795.
16.	张圣道，韩天权，汤耀主编. 重症急性胰腺炎临床新技术·上海第二医科大学附属瑞金医院继续教育丛书 \[M\]. 北京: 人民军医出版社, 2002∶11~17.
17.	Exley AR, Leese T, Holliday MP, et al. Endotoxemia and serum tumour necrosis factor as prognostic markers in severe acute pancreatitis [Ｊ]. Gut, 1992； 33(8)∶1126.
18.	梁馨苓，史伟, 梁永正, 等. 短时高容量血液滤过与间歇性血液透析治疗重症胰腺炎的疗效比较 [Ｊ]. 中国血液净化, 2003； 2(7)∶366.
19.	沈清，甘华, 杜晓刚, 等. 连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值 [Ｊ]. 中华内科杂志， 2003； 42(7)∶483.
20.	Nystrm PO, Bax R, Dellinger EP, et al. Proposed definitions for diagnosis, severity scoring, stratification and outcome for trials on intraabdominal infection. Joint Working Party of SIS North America and Europe [Ｊ]. World J Surg, 1990； 14(2)∶148.
21.	Bosscha K, Reijnders K, Hulstaert PF, et al. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis [Ｊ]. Br J Surg, 1997； 84(11)∶1532.

1. Chaing DT, Anozie A, Fleming WR , et al. Comparative study on acute pancreatitis management [Ｊ]. ANZ J Surg, 2004； 74(4)∶218.
2. 余文，吴伟，张少辉，等. 急性胰腺炎发病机理的研究进展 [Ｊ]. 中国普外基础与临床杂志， 2006； 13(6)∶733.
3. 中华医学会外科学分会胰腺外科学组. 重症急性胰腺炎诊治草案 [Ｊ]. 中国实用外科杂志, 2001； 21(9)∶513.
4. 孙诚谊，左石. 重症急性胰腺炎治疗中抗生素的合理应用 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)∶383.
5. Knaus WA, Draper EA, Wagner DP, et al. APACHEⅡ: a severity of disease classification system [Ｊ]. Crit Care Med, 1985； 13(10)∶818.
6. Balthazar EJ, Robison DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis [Ｊ]. Radiology, 1990； 174(2)∶331.
7. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [Ｊ]. JAMA, 1994； 271(3)∶226.
8. Norman J. The role of cytokines in the pathogenesis of acute pancreatitis [Ｊ]. Am J Surg, 1998； 175(1)∶76.
9. 毛恩强，汤耀卿，张圣道. 进一步改善重症急性胰腺炎预后的探讨 [Ｊ]. 中国实用外科杂志, 2003； 23(1)∶50.
10. 陶京，王春友, 杨智勇, 等. 血液滤过治疗重症急性胰腺炎患者血浆炎性细胞因子水平的影响 [Ｊ]. 中华普通外科杂志， 2004； 19(4)∶233.
11. 李金林，曹权. CVVH对重症急性胰腺炎器官损害保护的临床观察 [Ｊ]. 实用全科医学， 2006； 4(4)∶393.
12. 郑邦瑞，沈文律，文军，等. 丹参注射液对重症急性胰腺炎大鼠胰腺NF-κB活化的影响 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(4)∶392.
13. Zingarelli B, Sheehan M, Wong HR, et al. Nuclear factor-kappaB as a therapeutic target in critical care medicine [Ｊ]. Crit Care Med, 2003； 31(1 Suppl)∶ S105.
14. Curley PJ. Endotoxin, cellular immunce dysfunction and acutu pancreatitis [Ｊ]. Ann R Coll Surg Engl, 1996； 78(6)∶531.
15. Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observation in 100 consecutive episodes of DKA [Ｊ]. Am J Gastoenterol, 2000； 95(10)∶2795.
16. 张圣道，韩天权，汤耀主编. 重症急性胰腺炎临床新技术·上海第二医科大学附属瑞金医院继续教育丛书 \[M\]. 北京: 人民军医出版社, 2002∶11~17.
17. Exley AR, Leese T, Holliday MP, et al. Endotoxemia and serum tumour necrosis factor as prognostic markers in severe acute pancreatitis [Ｊ]. Gut, 1992； 33(8)∶1126.
18. 梁馨苓，史伟, 梁永正, 等. 短时高容量血液滤过与间歇性血液透析治疗重症胰腺炎的疗效比较 [Ｊ]. 中国血液净化, 2003； 2(7)∶366.
19. 沈清，甘华, 杜晓刚, 等. 连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值 [Ｊ]. 中华内科杂志， 2003； 42(7)∶483.
20. Nystrm PO, Bax R, Dellinger EP, et al. Proposed definitions for diagnosis, severity scoring, stratification and outcome for trials on intraabdominal infection. Joint Working Party of SIS North America and Europe [Ｊ]. World J Surg, 1990； 14(2)∶148.
21. Bosscha K, Reijnders K, Hulstaert PF, et al. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis [Ｊ]. Br J Surg, 1997； 84(11)∶1532.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Early Repeated Intermittent Veno-Venous Hemofiltration in Treatment of Severe Acute Pancreatitis

Abstract Full text Figures/Tables Video References Cited by

Format

Content