The Mechanisms Of Treating Severe Acute Pancreatitis With Continuous Blood Purification

Objectives To study the mechanisms of treating severe acute pancreatitis (SAP) with continuous blood purification(CBP). Methods 10 SAP patients were chosen and treated with CBP. Blood biochemical index, blood routine, gas analysis, tumor necrosis factor a (TNF a ) and clotting index were tested in pre-,intra- and post-treatment of CBP. Meanwhile, heart rate, mean arterial pressure (MAP), central venous pressure (CVP), respiratory rate, temperature were recorded. APACHE II, SAPS II and MODS scores were graded. Results To compare with pre-treatment, APACHE II, SAPS II and MODS scores became decreased in the second morning of intra-treatment and the next morning of post-treatment. Oxygenation index (PO2/FiO2 was improved obviously. Heart rate, CVP, MAP and pressure-adjusted heart rate (PAHR) during treatment were decreased. It was positive correlation with the amount of dehydration by CBP that the difference of the FiO2/PO2 and PAHR between that of the next morning pretreatment and that of intra-treatment. The amount of dehydration was negative correlation with MODS score in the second morning during treatment. BUN, Cr and uric acid were decreased during CBP. And the longer time, the lower scores. Those scores were returned after CBP. Blood HCOs", calcium and magnesium of intra-treatment were higher than those of pre-treatment. Hct was decreased, but WBC was increased during and after treatment obviously. TNF a was not decreased significantly after treatment. Conclusions The improvement of cardiac and pulmonary function was concerned with relieving interstitial edema of organization after dehydration by CBP. The longer time was better for clearing BUN and Cr. The time of CBP could be shorted for the patients with normal BUN and Cr. The mechanisms of treating severe acute pancreatitiswith continuous blood purification was not by removing TNF α according to the change of TNF a before, during and after treatment.