Hemofiltration In Treatment Of Severe Acute Pancreatitis

ObjectiveIn this study, we cooperated hemofiltration (HF) in treatment of severe acute pancreatitis (SAP) and investigated the efficacy of HF in treatment of SAP.Material&Methods14 SAP patients were involved that stay in our hospital from January 2005 to March 2009, include male 8 and female 6, from 27 to 69 years old, the average age is 49.5±14.3. All the patients meet the diagnostic criteria of SAP that Guide diagnosis and treatment of severe acute pancreatitis setting In Xining, the 11th National Pancreatic Surgery Symposium on the development of pancreatic surgery. The complications of SAP including SIRS in 2 patients, ARDS in 10 patients, ARF in 9 patients, heart failure in 5 patients, liver failure in 3 patients,gastrointestinal bleeding in 4 patients, pancreatitic encephalopathy in 2 patients, MODS in 5 patients and Septic shock in 5 patients. All patients were given to prohibition of eating and drinking water, gastrointestinal decompression, use H2 receptor blockers, inhibition of pancreatic exocrine (Somatostatin), anti-infection, the treatment of parenteral nutrition support. Dyspnea in patients with the use of mechanical ventilation treatment, four cases of patients with intra-abdominal drainage, 2 cases of emergency laparotomy. Hemofiltration treatment did at the same time. We observed before treatment, 24-48 h after treatment and after cessation of hemofiltration within 24 hours, patients with body temperature, heart rate, blood pressure, mean arterial pressure, respiration and other vital signs were observed in patients with signs of the spirit of the nervous system changes. Collecting blood, serum amylase, urinary amylase,liver and kidney function, electrolytes, blood glucose, blood gas analysis and other tests. The results with M±Q, the use of randomized block design data rank test (Friedman rank sum test). P≤0.05 indicated statistically significant difference, P<0.01 indicated that the difference was significant.ResultsAfter hemofiltration treatment, All patients improved than those in pre-treatment in which pulse,blood pressure, mean arterial pressure, calcium, renal function (BUN, Cr), blood, urine amylase, blood PH value, and APACHE II score. Abdominal pain, abdominal distension significantly ease. But in patients with body temperature, respiratory rate, liver enzymes, potassium, sodium, glucose, leukocytes and oxygen saturation did not have statistically significant improvement. 6 cases of patients with improved clinical performance, Sense of clear, respiratory rate and heart rate dropped to normal, normal body temperature, blood pressure stable, four cases in which a turn for the better discharge, 2 patients can not be restored due to renal function and transferred to the treatment of kidney disease section, and finally were discharged from hospital. Three cases of patients with septic shock, got to reduce or disabled step-up drugs. Patients with pancreatic encephalopathy improve the state of consciousness, Dan jump, symptoms such as irritability significantly reduced after treatment. Eight cases of death in patients with pre-treatment state of consciousness improved, improved patient serological indicators have significantly improved to the normal serum amylase, liver, kidney function improved significantly. 14 cases after hemofiltration APACHE II score were significantly decreased.Conclusion1. Hemofiltration is a safe and effective method of blood purification and in favor of hemodynamic stability.2. Hemofiltration can improve the patient's renal function..3. Hemofiltration can improve the patient's APACHE II score.4.Hemofiltration provides an effective treatment for severe acute pancreatitis.5.Hemofiltration can improve the success rate of treatment for SAP patients to reduce mortality.6.Hemofiltration can improve the general status of patients with SAP, correcting water, electrolyte and acid-base disturbance.7.Hemofiltration reduces the excessive inflammatory response and prevent multiple organ failure.