| BackgroundAcute pancreatitis(acute pancreatitis,AP)is a very common disease all over the world,with an incidence ranging from 30 to 50 per 100,000 people,causing a huge social medical burden for people in various countries.Among them,severe acute pancreatitis(severe acute pancreatitis,SAP)is often accompanied by local complications and failure of some organ functions,and the mortality rate can reach up to 10-30%.In recent years,continuous blood purification(CBP)technology has been clinically applied to treat SAP,and it has been found that it can effectively control the level of inflammation in the patient’s body and improve the prognosis.Commonly used techniques for CBP include high-volume veno-venoushemofiltration(high-volume hemofiltration,HVHF),continuous veno-venous hemofiltration(CVVH),etc.ObjectiveTo compare the clinical effect of CVVH combined with conventional medical treatment and conventional medical treatment alone;to explore the application value of CVVH in the treatment of SAP;to analyze the risk factors of SAP combined with acute kidney injury(AKI);to analyzethe impact of CVVH mode in the prognosis of SAP and related risk factors.MethodsDuring 2016 to 2020,the relevant data of patients with hospitalized SAP patients were reviewed..According to different clinical treatment strategies,the cases were divided into a control group(25 cases)with conventional internal medicine treatment and an observation group(52 cases)with blood purification combined with conventional internal medicine treatment.Patients in the observation group with AKI(41 cases)were divided into two groups,according to different stages of AKI Phase 1 group(29 cases)and AKI phase 2/3 group(12 cases),compare observation group and control group,AKI phase 1group and AKI phase 2/3 group,respectively,general data,clinical symptoms,biochemical and inflammatory score indicators,changes in T cell subsets between groups Conditions,mortality,and proportion of complications,and explore the risk factors that affect the prognosis of the observation group and the risk factors of SAP combined with AKI.Results1.Comparative analysis of observation group and control groupAPACHE Ⅱ scores when they are admitted,and the differences between groups are not large.There is no statistical significance(P>0.05).The observation group and the control group were admitted to ICU for 10(4,30)days and 13(7,26),respectively,and the median time for relief of abdominal pain was 4(3,6)days and 5(3,9)days,respectively The median duration of systemic inflammatory response syndrome(SIRS)was 6(4,13)days and 8(5,15)days,respectively.The above differences between the two groups were statistically significant.Comparison of serum lipase,serum amylase,serum creatinine,total bilirubin,procalcitonin,etc.There is a significant difference between the two groups after a week after admission and standardized treatment(P<0.05).There was no significant difference in C-Reactive Protein(CRP)after two groups.After 7 days of observation group,CD3 +,CD4 + percent and CD4 + / CD8 + value were significantly better than the control group.The observation group was 23.1%(12 cases / 52 case),and the control group was 20%(5 cases / 25 cases),and the difference between the two was not statistically significant(P>0.05).The observation group mortality was 17.3%(9/52 cases),and the mortality rate of the control group was 24.0%(6 cases / 25 cases),the difference in mortality between the two groups was statistically significant(P<0.05).2.Comparative analysis of AKI stage 1 group and AKI stage 2/3 group of patients with acute kidney injury in the observation groupThere was no statistically significant difference in the APACHE Ⅱ score between AKI1 group and AKI 2/3 admission(P>0.05).The median time of SIRS in AKI 1 group and AKI 2/3 was 7(3,9)days and 10(8,16)days,respectively.The difference between the two groups was statistically significant(P<0.05).The AKI-1 group and the AKI-2/3 group have different time to significant relief of abdominal pain,and the time of admission to the ICU is different,and the difference is statistically significant.The AKI 1 group is compared with the AKI 2/3 group of patients: abdominal pain was significantly relieved and staying in the ICU time was shorter.The median time for urine output in the AKI 1 and AKI 2/3 group to recover to 400ml/d was 7(2,10)days and 9(4,14)days respectively,the difference was statistically significant;treatment Seven days later,there was a statistically significant difference in the proportion of blood creatinine and blood urea nitrogen returning to normal between the two subgroups,and the AKI 1 stage was better than the AKI 2/3 group.After 7 days of treatment,the CD3 +,CD4 + percent and CD4 + / CD4 +percent and CD4 + / CD8 + value of the T cell subsets in the AKI 1 group were significantly better than those of the AKI 2/3 group.The mortality ratio of AKI 1 was 20.7%(6 cases / 29),and the mortality rate of AKI 2/3 period was 25.0%(3 cases / 12 cases),and the difference between the two groups of mortality was not large,no statistics intelligence((?)=0.021,P>0.05).3.Analysis of risk factors.The logistic regression model analyzed the prognostic outcome(survival and death)of CVVH treatment of SAP.It can be seen that APACHEII score and respiratory failure at admission are important risk factors that affect the prognosis of SAP under CVVH treatment.Logistic regression analysis results show that the duration of SIRS more than 3days and abnormal increase of BUN are an important risk factor for SAP combined with AKI.ConclusionCVVH can effectively reduce the inflammation-related indicators in the blood of SAP patients,down-regulate the inflammatory response of SAP patients,relieve acute kidney damage,improve their clinical symptoms,immune function and patient prognosis,without significantly increasing the occurrence of adverse reactions during treatment rate.The earlier SAP combined with acute kidney injury,the better the protection of the remaining kidneys with continuous blood purification treatment.The APACHE Ⅱ score,respiratory failure during admission is an important risk factor affecting the prognosis of SAP.Systemic inflammatory response syndrome(SIRS)lasting more than 3 days and abnormally elevated BUN are two independent risk factors for SAP combined with AKI. |
