Wang Hao, Li Wei-Qin, Zhou Wei, Li Ning, Li Jie-Shou
Department of Surgery, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China.
World J Gastroenterol. 2003 Sep;9(9):2096-9. doi: 10.3748/wjg.v9.i9.2096.
To investigate the efficiency of continuous high volume hemofiltration (HVHF) in the treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).
A total of 28 SAP patients with an average of 14.36+/-3.96 APACHE II score were involved. Diagnostic criteria for SAP standardized by the Chinese Medical Association and diagnostic criteria for MODS standardized by American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM) were applied for inclusion. HVHF was started 6.0+/-6.1 (1-30) days after onset of the disease and sustained for at least 72 hours, AN69 hemofilter (1.2 m(2)) was changed every 24 hours. The ultrafiltration rate during HVHF was 4 000 ml/h, blood flow rate was 250-300 ml/min, and the substitute fluid was infused with pre-dilution. Low molecular weight heparin was used for anticoagulation.
HVHF was well tolerated in all the patients, and lasted for 4.04+/-3.99 (3-24) days. 20 of the patients survived, 6 patients died and 2 of the patients quited for financial reason. The ICU mortality was 21.4 %. Body temperature, heart rate and breath rate decreased significantly after HVHF. APACHE II score was 14.4+/-3.9 before HVHF, and 9.9+/-4.3 after HVHF, which decreased significantly (P<0.01). Partial pressure of oxygen in arterial blood before HVHF was 68.5+/-19.5 mmHg, and increased significantly after HVHF, which was 91.9+/-25 mmHg (P<0.01). During HVHF the hemodynamics was stable, and serum potassium, sodium, chlorine, glucose and pH were at normal level.
HVHF is technically possible in SAP patients complicated with MODS. It does not appear to have detrimental effects and may have beneficial effects. Continuous HVHF, which seldom disturbs the hemodynamics and causes few side-effects, is expected to become a beneficial adjunct therapy for SAP complicated with MODS.
探讨持续高容量血液滤过（HVHF）治疗重症急性胰腺炎（SAP）合并多器官功能障碍综合征（MODS）的疗效。
纳入28例SAP患者，急性生理与慢性健康状况评分系统（APACHE II）平均评分为14.36±3.96分。采用中华医学会制定的SAP诊断标准以及美国胸科医师学会（ACCP）和危重病医学会（SCCM）制定的MODS诊断标准进行病例入选。在发病6.0±6.1（1 - 30）天后开始进行HVHF，持续至少72小时，每24小时更换AN69血液滤过器（1.2 m²）。HVHF期间超滤率为4000 ml/h，血流速度为250 - 300 ml/min，置换液采用前稀释输入。使用低分子量肝素进行抗凝。
所有患者对HVHF耐受性良好，持续时间为4.04±3.99（3 - 24）天。20例患者存活，6例死亡，2例因经济原因退出。重症监护病房（ICU）死亡率为21.4%。HVHF后体温、心率和呼吸频率显著下降。HVHF前APACHE II评分为14.4±3.9，HVHF后为9.9±4.3，显著降低（P<0.01）。HVHF前动脉血氧分压为68.5±19.5 mmHg，HVHF后显著升高，为91.9±25 mmHg（P<0.01）。HVHF期间血流动力学稳定，血清钾、钠、氯、葡萄糖和pH值均在正常水平。
HVHF应用于合并MODS的SAP患者在技术上是可行的。它似乎没有有害影响，可能具有有益作用。持续HVHF很少干扰血流动力学且副作用少，有望成为治疗合并MODS的SAP的有益辅助治疗方法。
