Application Of Continuous Renal Replacement Therapy In Severe Acute Pancreatitis In Dogs

Objective: Growing in recent years,along with the age and obesity pets,dogs and cats,there is an upward trend in incidence of acute pancreatitis,Severe acute pancreatitis(Severe acute pancreatitis,SAP)course,mortality is high,need to seek new treatments,in order to improve the cure rate.The present study found that the central link of the occurrence and development of SAP was excessive activation of inflammatory mediators.Continuous venous hemofiltration(CVVH)model in continuous renal replacement therapy(CRRT)can effectively remove substances of 500-5000 da size in extracorporeal circulation,including 22 important inflammatory mediators such as tumor necrosis factor.There have been many reports about the use of CRRT in the treatment of SAP in developed countries.Although there are sporadic reports about the clinical treatment of pets in China,systematic studies are few.In this paper,the effect of CRRT on SAP treatment was systematically evaluated and the experience was summarized.Methods: The diagnostic criteria of SAP were clinical symptoms of vomiting and diarrhea;the depth of the detection point was greater than that of the control point by cPL;abnormal echo of pancreatic structure by ultrasound;and renal insufficiency.According to the above criteria,85 SAP cases were selected from a hospital in Chengdu from September28,2016 to December 31,2018.They were divided into two groups.The control group was treated with simple medical infusion(40 cases),and the treatment group was treated with internal medicine combined with CRRT(45 cases).Firstly,we evaluated the effect of CRRT on SAP by measuring hematological changes(whole blood cell count,inflammatory response protein,urea,creatinine and related enzymes),ultrasound images and symptoms.Secondly,according to the serum creatinine level and clinical symptoms,the patients in each group were divided into six groups: oliguria,anemia,jaundice,non-jaundice and hypertension to evaluate the therapeutic effect.Results: Rehabilitation and chronic outcome were survival in 85 cases.The control group survived 32.5%(13 cases)and the treatment group survived 53.3%(24 cases).In the control group,oliguria cases survived 0%,anemia cases survived 21.4%,jaundice cases survived 30.8%,non-jaundice cases survived 33.3%,hypertension cases survived 24.1%,serum creatinine < 795 mg/dL cases survived 53.3%.Serum creatinine796-954 mg/dL cases survived 27.3%,serum creatinine 955-1113 mg/dL cases survived9.1%,serum creatinine > 1114 mg/dL cases survived 0%.In the treatment group,oliguria cases survived 66.7%,anemia cases survived 0%,jaundice cases survived 36%,non-jaundice cases survived 59%,hypertension cases survived 42%,serum creatinine < 795 mg/dL cases survived 61.6%,serum creatinine796-954 mg/dL cases survived 53.4%,serum creatinine 955-1113 mg/dL cases survived50%,serum creatinine > 1114 mg/dL cases survived 40%.Conclusion:Combined CRRT treatment can improve the cure rate of SAP in general;combined CRRT treatment can improve the cure rate in SAP with oliguria,hypertension,non-jaundice clinical symptoms and serum creatinine concentration at all levels;combined CRRT treatment can not improve the mortality rate in SAP with jaundice;the presupposed condition of using whole blood pre-filling pipeline in dogs below 15 kg is not conducive to the treatment of SAP patients with anemia by CRRT technique.