Continuous Venovenous Hemofiltration In The Treatment Of Severe Acute Pancreatitis

Backgrounds and aims Severe acute pancreatitis(SAP) is a life-threatening disease which has a high mortality. The course of SAP develops in systemic inflammatory response syndrome(SIRS) and subsequent infection two phases. It is a key point that controlling the inflammation in the SIRS phase to the treatment of SAP for the sake of the threat of SIRS to the SAP patients.In recent years, many studies have demonstrated that continuous venovenous hemofiltration(CVVH) can ameliorate the outcome of the SAP through controlling the inflammatory response. However, there are controversies about the treatment effect of CVVH to SAP and few studies about whether the starting time of CVVH has influence on the outcome of the SAP. So this article aims at studying the effort of CVVH and the starting time of CVVH to SAP.Methods: Systemically review the history of the patients who were diagnosed severe acute pancreatitis according to the pancreatitis guideline of China and Atlanta II standard in our hospital from 2003 to 2014.We classed those parents into three groups which include NCVVH, <48h(CVVH),>48h(CVVH) respectively according to the difference style of the treatments and the starting time of the CVVH. Next we analyzed the age and sex,mortality, abdominal pain extinction time, abdomen distention relief Time, APACHE II score, mean length of stay in hospital and the incidence of intra-abdominal hypertension(IAH)/ abdominal compartment syndrome(ACS) and necrosis and infection of pancreas in the every group.Results: 248 sex- and age-matched SAP were included. The patients of NCVVH, <48h(CVVH),>48h(CVVH) group are 199,23,29 respectively. There is no significant difference in every group about age and sex(p>0.05). The main causes of SAP are gallstones and alcohol. The Abdominal Pain Extinction Time, Abdomen Distention Relief Time, Mean Length of stay in hospital of NCVVH group are longer Comparing to which of<48h(CVVH)and >48h(CVVH)group(p<0.05). The incidence of complications and the mortality NCVVH group are higher than which of<48h(CVVH)and >48h(CVVH)group(p<0.05). The Acute physiology and Chronic Health Examination(APACHE)-II Score of <48h(CVVH)and >48h(CVVH)group decreased significantly at the 48 hours,72hours,7day after admission compared with that of NCVVH group(p<0.05).There are no significant difference about the incidence of complications and mortality between the <48h(CVVH)group and >48h(CVVH)group(p>0.05). However, the Abdominal Pain Extinction Time, Abdomen Distention Relief Time, Mean Length of stay in hospital of >48h(CVVH) group are longer Comparing to which of<48h(CVVH)group(p<0.05).Conclusions:1. CVVH can improve the outcome of SAP including decreasing the APET, ADRT, mean length of stay in hospital, APACHE II score, mortality and the incidence of complications.2. The validity of CVVH which begins within the 48 hours after the diagnosis of SAP will be superior to which of the CVVH beginning after the 48 hours after the diagnosis of SAP.