Clinical Study Of Bedside Coupled Plasma Filtration Adsorption In Treatment Of Severe Acute Pancreatitis

Objective To study the treatment effect of routine internal medicine therapy and routine internal medicine therapy combined with coupled plasma filtration adsorption in treatment of severe acute pancreatitis and study the application value of CPFA in the treatment of SAP.Methods 40 patients with SAP in our hospital from January 2014 to January 2016 were selected to study.40 patients were divided into CPFA group 22 patients and control group with 18 patients each group.The control group received routine internal medicine therapy and CPFA group received CPFA therapy based on routine internal medicine therapy.The clinical symptoms and vital signs of the patients were closely watched during the course of treatment.The APACHEⅡ score,TNF-α,IL-1β,IL-6,IL-10,routine blood tests,liver function tests,renal function tests,serum amylase,urine amylase of patients in two groups were observed before and 7d after treatment,while the mortality rates of patients at 28 d and adverse reactions during treatment in two groups were observed.Results1.The ALT,AST,TBIL,ALB,WBC,RBC,serum amylase,urine amylase,BUN,Scr of control group after treatment were lower than those before treatment with significant difference(p<0.05),and there was no statistically significant in PLT between before and after treatment(p>0.05).The ALT,AST,TBIL,ALB,WBC,RBC,serum amylase,urine amylase,BUN,Scr of CPFA group after treatment were lower than those before treatment with significant difference(p < 0.05),and there was no statistically significant in PLT between before and after treatment(p >0.05).The ALT,AST,TBIL,ALB,WBC,RBC,serum amylase,urine amylase,BUN,Scr of CPFA group were lower than those of control group at 7d with significant difference(p<0.05),and there was no statistically significant in PLT between two groups(p>0.05).2.The level of TNF-α,IL-1β,IL-6 in control group after treatment were lower than those before treatment with significant difference(p < 0.05 or 0.01).Level of IL-10 in control group after treament was lower than those before treatment with significant difference(p<0.01).The level of TNF-α,IL-1β,IL-6 in CPFA group after treatment were lower than those before treatment with significant difference(p<0.01).Level of IL-10 in CPFA group after treament was lower than that before treatment with significant difference(p<0.01).The level of TNF-α,IL-1β,IL-6 in CPFA group after treatment were lower than those in control group with significant difference(p<0.05 or 0.01).Level of IL-10 in CPFA group after treament was lower than that in control group with significant difference(p<0.01).3.The oxygenation index and MAP of control group after treatment were obviously higher than those before treatment with significant difference(p < 0.05 or 0.01).The APACHEⅡ score was obviously lower than that before treatment with significant difference(p<0.05).The oxygenation index and MAP of CPFA group after treatment were obviously higher than those before treatment and APACHEⅡ score was obviously lower than that before treatment with significant difference(p<0.05).The oxygenation index and MAP of CPFA group after treatment were obviously higher than those of control group and APACHEⅡ score of CPFA group was obviously lower than that of control with significant difference(p<0.05).4.The time of recovery of fever,abdominal distension,nausea and vomiting,blood amylase of control were respectively(3.2±0.7)d,(6.84±1.4)d,(3.1±0.7)d,(7.9±0.9)d and(23.4±7.2)d,and the time of recovery of fever,abdominal distension,nausea and vomiting,blood amylase of control were respectively(1.9±0.4)d,(2.2±0.3)d,(5.1±1.2)d,(7.9±0.9)d and(15.8±5.5)d.There were significant difference in recovery of fever,abdominaldistension,nausea and vomiting,blood amylase between groups(p<0.05).5.The mortality rates of patients at 28 d in control group and CPFA were respectively15% and 5%,and there was no significant difference in mortality rates of patients at 28 d between two groups(p>0.05).The patients of CPFA group did not appear allergic shock,low platelet coagulation,hemorrhage,hypotension and other adverse complications.Conclusion CPFA in treatment of patients with SAP can effectively reduce the level of inflammatory factors,improve the biochemical and physiological indexes of patients,shorten the time of symptom improvement and hospital stay,and has high clinical application value.