Zhang Xujie, Sun Shiren, Li Shujun, Feng Xiangying, Wang Shiqi, Liu Chaoxu, Hang Zhenning, Tong Chao, Zhu Cailin, Bai Bin, Xu Bin, Feng Quanxin, Zhao Qingchuan
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
Artif Organs. 2014 Apr;38(4):335-41. doi: 10.1111/aor.12159. Epub 2013 Sep 11.
Continuous venovenous hemofiltration (CVVH) is an important organ supportive technique. This study aimed to evaluate the impact of early classic CVVH on the outcomes of severe acute pancreatitis (SAP) patients with early organ failure (EOF). Between 2008 and 2012, a total of 44 SAP patients with EOF were admitted to our department. The 44 patients were classified into two groups according to whether they received early classic CVVH (2 L/h, initiated within 24 h after admission): 25 patients received early CVVH (ECVVH group), and 19 patients did not receive early CVVH (control group). The two groups were matched for age and Acute Physiology and Chronic Health Evaluation II scores. The severity of organ dysfunctions was evaluated by Sequential Organ Failure Assessment (SOFA) scores. Each group included 19 patients. The baseline characters between the two groups were balanced. The SOFA scores in the ECVVH group increased compared with those in the control group. The time to weaning from mechanical ventilation was significantly longer in the ECVVH group (log-rank test: χ(2) = 4.007, P = 0.045). Renal support was also significantly prolonged in the ECVVH group (the number of patients receiving CVVH 72 h after admission: 10 vs. 3, respectively, P = 0.038). Nine patients died in the ECVVH group versus six patients in the control group (P = 0.508). In conclusion, our study failed to prove that early classic CVVH had any benefits on the outcomes of SAP patients with EOF. Unexpectedly, early classic CVVH worsened organ functional capacity. However, it is possible that CVVH using advanced techniques may be beneficial in SAP patients with EOF.
持续静静脉血液滤过（CVVH）是一项重要的器官支持技术。本研究旨在评估早期经典CVVH对伴有早期器官功能衰竭（EOF）的重症急性胰腺炎（SAP）患者预后的影响。2008年至2012年期间，共有44例伴有EOF的SAP患者入住我科。根据是否接受早期经典CVVH（2 L/h，入院后24小时内开始）将这44例患者分为两组：25例患者接受早期CVVH（早期持续静静脉血液滤过组），19例患者未接受早期CVVH（对照组）。两组在年龄和急性生理与慢性健康状况评分系统II评分方面相匹配。采用序贯器官衰竭评估（SOFA）评分评估器官功能障碍的严重程度。每组各有19例患者。两组之间的基线特征均衡。早期持续静静脉血液滤过组的SOFA评分较对照组升高。早期持续静静脉血液滤过组机械通气脱机时间显著延长（对数秩检验：χ(2) = 4.007，P = 0.045）。早期持续静静脉血液滤过组肾脏支持时间也显著延长（入院后72小时接受CVVH的患者数量：分别为10例和3例，P = 0.038）。早期持续静静脉血液滤过组有9例患者死亡，对照组有6例患者死亡（P = 0.508）。总之，我们的研究未能证明早期经典CVVH对伴有EOF的SAP患者的预后有任何益处。出乎意料的是，早期经典CVVH使器官功能能力恶化。然而，采用先进技术的CVVH可能对伴有EOF的SAP患者有益。
