The Clinical Research Of The Hybrid Sequential Blood Purification Therapy Combined With Alprostadil In The Treatment Of Severe Acute Pancreatitis

Severe acute pancreatitis(SAP)is a critical condition,which caused by complex pathogenesis.It is been considerated that the damaged pancreatic tissue activates macrophages to release proinflammatory cytokines,resulting in pancreatic microcirculation dysfunction,and starting the pancreas persistent damage mechanism,which including the early pancreatic edema,hemorrhage and necrosis,and resulting in organ failure.In the tendency to non-surgical treatment of today,rapid removal of proinflammatory factors and improving pancreatic microcirculation in the treatment of non surgical treatment is the first choice for blocking the progression of severe acute pancreatitis.At present,the continuous blood purification technology in surgery for removal of inflammatory cytokines have been applied to the treatment of SAP,but the effect is mixed.A single CBP model is also difficult to achieve the goal of completely blocking the progression of inflammation.This study was designed to observe the hybrid sequential blood purification therapy combined with alprostadil in the treatment of severe acute pancreatitis,combinating with the use of blood purification in the adsorption,diffusion,convection,the principle of the maximum clearance of proinflammatory factors.At the same time,combining with alprostadil lipid microsphere injection,we can detecte the changes of ET and CGRP before and after treatment in order to investigate the effect of alprostadil in the microcirculation by enzyme-linked immuneosorbent assay.Combined the treatment of the two is expected to provide a better treatment for the severe acute pancreatitis.Objective: The study of hybrid sequential blood purification therapy combined with alprostadil in clinical efficacy in patients with severe acute pancreatitis,provide better treatment options for treatment in severe acutepancreatitis.Method: From June 2015 to July 2016,60 cases of patients with severe acute pancreatitis who were admitted to the emergency department,the Department of digestive medicine and the intensive medicine department of the First Affiliated Hospital of Hebei North University were selected as the research objects.Randomly divided into hemofiltration group and sequential group and combined group,20 cases in each group.The age,gender and APACHE score,procalcitonin(PCT)of the three groups showed no significant difference(P>0.05),so they can be compared.Three groups of patients were given routine bundle treatment.The hemofiltration group was given of continuous veno-venous hemofiltration(continuous veno-venous,hemofiltration,CVVH)sequential therapy on the basis treatment;Patients of sequential administration were given of hemoperfusion(Hemoperfusion,HP)and CVVH treatment on the basis treatment;The combined group was given alprostadil on the basis treatment of sequential group.The three groups were compared before the treatment and after 3 days of treatment and 1 week of treatment.Acute physiology and chronic health evaluation II(APACHE II)score;vital signs and oxygenation index(PaO2/FiO2);procalcitonin(PCT)and C reactive protein(CRP),tumor necrosis factor alpha(TNF-alpha);white blood cells,serum amylase(AMY),serum calcium,serum creatinine(Cr);plasma endothelin(ET)and calcitonin gene related peptide(CGRP)concentration changes,and the change of ratio of ET/CGRP;disappearance time of abdominal pain,blood purification time,ICU stay time,efficiency and mortality rate.Results:1 Three groups of patients with APACHE II score was decreased.The comparison in the group: The change after 1 week of treatment and before treatment was statistically significant(P<0.05);The comparison of Group and Time point: the change was significant in the sequential group after 1 week of treatment than hemofiltration group(P<0.05);combination group in the treatment of 3 days or 1 week,compared with the other two groups wassignificant(P<0.05).2 The life signs of three groups showed improved trend.The comparison in the group: The change after 1 week of treatment and before treatment was statistically significant(P<0.05);The comparison of Group and Time point:the PaO2/FiO2 in the sequential group after 1 weeks of treatment was changed significantly than hemofiltration group(P<0.05);In the combined therapy group after 1 week treatment,the change of MAP and Pa O2/FiO2 was significant than the other two groups(P<0.05).3 Three groups of patients with PCT CRP and TNF-α were decreased.The comparison in the group: The change after 3 days of treatment and before treatment in sequential group and combined group PCT and TNF-α were statistically significant(P<0.05).After 1 week of treatment group compared with before treatment were statistically significant(P<0.05);Comparison of the time between the two groups: the change of PCT and TNF-α in sequential group and combined group in the treatment of 3 days and after 1 week was significant(P<0.05)than the hemofiltration group,and the inflammation factor of sequential group and combined group in the treatment of 3 days and after 1 week had no significant change(P>0.05).4 The white blood cell count,serum amylase,and creatinine of the three groups were decreased,but the serum calcium was increased;The comparison within group: the AMY and Cr of three groups in 3 days after treatment and before treatment were statistically significant(P<0.05).After 1 week of treatment compared with before treatment all indexes were statistically significant(P<0.05);The comparison of Group and Time point: three groups of patients in the treatment of 3 days and after 1 week the comparison of all indexes had no significant change(P>0.05).5 The ET,CGRP and ET/CGRP of the three groups of patients were decreased;The comparison within group: ET,the ratio of ET/CGRP after 1weeks of treatment in three groups were significantly lower than before treatment(P<0.05);Three groups of CGRP after treatment than before treatment showed no significant difference(P>0.05);The comparison ofGroup and Time point : the ET and ET/CGRP ratio of the Combined treatment group after 1 week than that of other groups were more significant changes(P<0.05).6 The abdominal pain vanished time,blood purification time,and in ICU time in the combined group were significantly less than that in the other two groups,and the change were significant(P<0.05)compared with the other two groups.Conclusion:1 The effect of using hybrid sequential blood purification therapy with Alprostadil to treat the severe acute pancreatitis is clear.The method can significantly shorten treatment time.2 The treatment of HP and CVVH sequential therapy can make full use of the principle of adsorption,diffusion,convection,effective removal of severe acute pancreatitis big,middle and small inflammatory factors,from the source to inhibit severe acute pancreatitis progress,reduce the systemic inflammatory response,improve inflammatory factor on microcirculation injury.It can win the time for repair of damaged pancreas.