Digestive Department, Affiliated Yidu Central Hospital of Weifang Medical College, Qingzhou, China.
Blood Purif. 2017;44(4):276-282. doi: 10.1159/000480223. Epub 2017 Oct 25.
The aim of this study was to evaluate the efficacy of early continuous veno-venous hemofiltration (CVVH) in decreasing the intra-abdominal pressure (IAP) and serum interleukin-8 (IL-8) level in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS).
Twenty-five ACS patients of SAP were enrolled in a prospective study conducted according to the standard management protocol. They were treated in the intensive care unit (ICU) of Affiliated Yidu Central Hospital of Weifang Medical College and underwent CVVH. Eleven patients were set up as the control group that received no hemofiltration and surgical treatment due to economic or other reasons but solely conventional treatment. Serum amylase, liver and kidney function, and C reactive protein were investigated before and after treatment. IAP and blood level of IL-8 were measured daily to investigate their time course of changes and the correlation between the 2 parameters.
Serum amylase levels, C-reactive protein and IAP were significantly lower and liver and kidney function was significantly better than those of the control group (p < 0.05). IAP on admission to the ICU was high, at 22.9 ± 2.1 mm Hg. The IAP was significantly lower to 17.2 ± 2.2 mm Hg (p < 0.01) 24 h after the initiation of CVVH, and thereafter decreased rapidly. The average blood level of IL-8 was high at 88.2 ± 25.1 ng/L on admission. However, it significantly decreased to 63.2 ± 18.7 ng/L (p < 0.01) 24 h after the initiation of CVVH, and subsequently decreased. There was a significant positive correlation between the blood level of IL-8 and IAP(r = 0.62, p < 0.01).
CVVH is effective to decrease the IAP and the blood level of IL-8 in ACS patients of SAP. The blood level of IL-8 was significantly correlated with IAP, suggesting that IL-8 might play an important role in the pathogenesis of ACS. Early CVVH appeared to be effective in the treatment of ACS in patients with SAP through the removal of causative cytokines such as IL-8, and it thereby decreased interstitial edema to lower IAP and should be applied in the early stage of ACS. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=480223.
本研究旨在评估早期持续静脉-静脉血液滤过（CVVH）降低腹腔内压（IAP）和血清白细胞介素-8（IL-8）水平对伴有腹腔间隔室综合征（ACS）的重症急性胰腺炎（SAP）患者的疗效。
25 例 ACS 合并 SAP 患者纳入前瞻性研究，按标准治疗方案进行治疗。患者入住潍坊医学院附属益都中心医院重症监护病房（ICU），接受 CVVH 治疗。11 例患者因经济或其他原因未接受血液滤过和手术治疗，但仅接受常规治疗，设为对照组。治疗前后检测血清淀粉酶、肝肾功能、C 反应蛋白。每天测量 IAP 和血液中 IL-8 的水平，以研究其变化过程和这两个参数之间的相关性。
与对照组相比，治疗后患者的血清淀粉酶水平、C 反应蛋白和 IAP 明显降低，肝肾功能明显改善（p < 0.05）。患者 ICU 入院时 IAP 较高，为 22.9 ± 2.1mmHg。CVVH 开始后 24 小时，IAP 明显下降至 17.2 ± 2.2mmHg（p < 0.01），此后迅速下降。入院时血液中 IL-8 的平均水平较高，为 88.2 ± 25.1ng/L。然而，CVVH 开始后 24 小时，其水平明显下降至 63.2 ± 18.7ng/L（p < 0.01），随后持续下降。IL-8 与 IAP 呈显著正相关（r = 0.62，p < 0.01）。
CVVH 可有效降低 SAP 合并 ACS 患者的 IAP 和血液中 IL-8 的水平。IL-8 与 IAP 呈显著正相关，提示 IL-8 可能在 ACS 的发病机制中起重要作用。早期 CVVH 通过清除白细胞介素-8 等致病细胞因子，治疗 SAP 合并 ACS 患者，有效降低间质水肿，降低 IAP，应在 ACS 早期应用。视频期刊俱乐部“Claudio Ronco 的卡布奇诺”，网址：http://www.karger.com/?doi=480223。
