连续性静脉-静脉血液滤过治疗急性坏死性胰腺炎

Continuous veno venous hemofiltration in treatment of acute necrotizing pancreatitis.

作者信息

Xie Honglang, Ji Daxi, Gong Dehua, Liu Yun, Xu Bin, Zhou Hong, Liu Zhihong, Li Leishi, Li Weiqin, Quan Zhufu, Li Jieshou

机构信息

Research Institute of Nephrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China.

出版信息

Chin Med J (Engl). 2003 Apr;116(4):549-53.

PMID:12875720

Abstract

OBJECTIVE

To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP).

METHODS

Thirteen ANP patients were involved in this study, including 4 females and 9 males, averaging 50.6 +/- 10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8.9 +/- 2.1. CVVH was maintained for at least 72 hours and the AN69 hemofilter (1.2 m(2)) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993.9 +/- 983.0 ml/h, the blood flow rate was 250 - 300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant.

RESULTS

CVVH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICU mortality of 23.1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE II score before CVVH was 15.2 +/- 6.5, but decreased significantly to 8.1 +/- 5.3, 7.5 +/- 4.9 and 8.0 +/- 5.2 at the 24th, 48th and 72nd hour after CVVH, respectively (P < 0.01). Serum concentration of IL-1beta and TNFalpha decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later. After CVVH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1beta and TNFalpha was 0.33 +/- 0.11 and 0.16 +/- 0.08.

CONCLUSION

CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1beta and TNFalpha; CVVH at early stages of SAP may contribute to the improvement of outcome.

摘要

目的

探讨持续静静脉血液滤过（CVVH）治疗急性坏死性胰腺炎（ANP）的有效性。

方法

本研究纳入13例ANP患者，其中女性4例，男性9例，平均年龄50.6±10.8岁。入院时CT扫描显示，2例患者胰腺体部坏死33%，3例患者坏死67%，其余8例患者坏死100%；CT严重程度评分为8.9±2.1。CVVH维持至少72小时，每24小时更换AN69血液滤过器（1.2 m²）。CVVH期间超滤率为2993.9±983.0 ml/h，血流速度为250 - 300 ml/min，置换液采用前稀释方式输注。使用低分子量肝素作为抗凝剂。

结果

所有患者对CVVH耐受性良好。2例患者出现血性腹腔引流液，但未观察到其他与CVVH相关的副作用。2例患者死于全身性真菌感染，另1例死于颅内真菌感染，ICU死亡率为23.1%。10例患者在ICU存活，但其中1例在出院前因与SAP无关的其他原因死亡。CVVH前APACHE II评分为15.2±6.5，但在CVVH后第24、48和72小时分别显著降至8.1±5.3、7.5±4.9和8.0±5.2（P<0.01）。使用新的血液滤过器后第6小时，IL-1β和TNFα血清浓度降至最低点，12小时后缓慢升至CVVH前水平。CVVH停止后，两种细胞因子血清水平在第120小时升至峰值，最终在第144小时下降。IL-1β和TNFα的筛滤系数（SC）分别为0.33±0.11和0.16±0.08。