The Protective Effect Of Early Abdominal Paracentesis Drainage On Kidney Injury In Severe Acute Pancreatitis

Objective:To investigate the protective effects of early Abdominal paracentesis drainage(APD)on acute kidney injury(AKI)in patients with severe acute pancreatitis(SAP)and its effect on clinical efficacy through retrospective control study.Methods:The clinical information of SAP patients admitted in general hospital of western theater command was analysed in a retrospective way.The pancreatitis database from the center of the general surgery in general hospital of western theater command was used as the main source of data.186 cases of patients from January,2011 to January,2020 were included in our study in strict accordance with the inclusion and exclusion criteria of this experiment.According to whether acute kidney injury(AKI)had occurred on admission,the SAP patients were divided into AKI group(57 cases)and non-AKI group(129 cases).According to whether APD was performed,the AKI group was divided into AKIAPD(30 cases)and AKInon-APD(27 cases)subgroups,and the non-AKI group was also divided into non-AKIAPD(65 cases)and non-AKInon-APD(64 cases)subgroups.Acute kidney injury staging(AKIN staging),renal function index(creatinine,ureophil,uric acid,and cyscatin-C),inflammation index(IL-1,IL-6,IL-8,TNF-α,hypersensitive c-reactive protein),APACHE Ⅱ score and et al before and after clinical treatment were analysed and compared,using the statistical methods,between two subgroups of AKI group(AKIAPD,AKInon.APD)and two subgroups of non-AKI group(non-AKIAPD,non-AKInon-APD),respectively.P<0.05 was considered statistically significant.Results:(1)Comparison between two subgroups(AKIAPD and AKInon-APD)in AKI group:24 patients in the AKIAPD group had the descended to lower stages of AKIN within 2 weeks,and the descending rate is 80%;and 0 patients ascended to higher stages,so the ascending rate is 0%.In the AKInon-APD group,14 patients were descended to lower stages of AKIN within 2 weeks,and the rate of descending stage was 51.9%;and 5 patients were ascended to higher stages,so the rate of ascending stage was 18.5%.The descending rate of stagein AKInon-APD group was significantly higher than that in AKInon-APD group(χ2=5.067,P=0.024),but the ascending stage rate was significantly lower than that in AKInon-APD group(P=0.019).In addition,compared with those before treatment,renal function indexes(creatinine,ureophil,uric acid,and cyscatin-C),inflammation index(IL-1,IL-6,IL-8,TNF-a,hypersensitive c-reactive protein),and APACHE Ⅱ scores 7 days after the treatment in two subgroups were lower,but the descending extent of the indicators in AKIAPD group were obviously superior to AKInon-APD group(P<0.05);(2)Comparison between the two subgroups(non-AKIAPD and non-AKInon-APD)in the non-AKI group:3 patients in the non-AKIAPD group had ascended to higher stages of AKIN within 2 weeks,and the ascending stage rate was 4.6%;In the non-AKInon-APD group,11 patients were changed to higher AKIN stages,with a rate of 17.2%.The ascending stage rate of the non-AKIAPD group was significantly lower than that of the non-AKIAPD group.It means that the incidence of acute kidney injury in the non-AKIAPD group was 4.6%,which was significantly lower than that of the non-AKIAPD group(17.2%),and the difference was statistically significant(χ2=5.268,P=0.022).In addition,compared with those before treatment,renal function indexes(creatinine,ureophil,uric acid,and cyscatin-C),inflammation index(IL-1,IL-6,IL-8,TNF-α,hypersensitive c-reactive protein),and APACHE II scores 7 days after the treatment in two subgroups were lower,and non-AKIAPD group reduce the larger degree of every index than that of non-AKInon-APD group(P<0.05).Conclusion:(1)For SAP patients with AKI on admission,APD treatment in early stage can not only effectively reduce the renal function stage and renal function indexes,but also significantly decrease the serun inflammatory indexes and improve the systemic inflammatory state.(2)For SAP patients without AKI at the time of admission,APD treatment in early phase can not only effectively reduce the incidence of AKI and renal function indexes,and prevent renal injury,but also significantly reduce the serum inflammatory indexes and improve systemic inflammatory state.To sum up,for SAP patients with or without AKI on admission,performing APD treatment in early stage not only can effectively improve the renal function in patients with AKI,and reduce the incidence of kidney injury in patients without AKI on admission,but also can effectively reduce the harmful index and improve the state of inflammation,resulting in effective prevention and treatment of renal injury clinically.