Continuous veno venous hemofiltration in treatment of acute necrotizing pancreatitis

• Published in: Chinese medical journal Vol. 116; no. 4; pp. 549 - 553
• Main Author: 谢红浪 季大玺 龚德华 刘芸 徐斌 周红 刘志红 黎磊石 李维勤 全竹富 黎介寿
• Format: Journal Article
• Language: English
• Published: China Research Institute of Nephrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China%Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China 01.04.2003
• Subjects: Adult; Aged; Female; Hemofiltration - adverse effects; Humans; Interleukin-1 - analysis; Male; Middle Aged; Pancreatitis, Acute Necrotizing - therapy; Tumor Necrosis Factor-alpha - analysis; 多器官功能障碍综合征; 急性坏死性胰腺炎; 持续静脉-静脉内血液过滤治疗; veno venous hemofilration; multiple organ dysfunction syndrome; acute necrotizing pancreatitis
• ISSN: 0366-6999; 2542-5641

Objective To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH)in the treatment of acute necrotizing pancreatitis (ANP).Methods Thirteen ANP patients were involved in this study, including 4 females and 9 males,averaging 50. 6 ± 10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CTseverity score was 8. 9 ± 2. 1. CWH was maintained for at least 72 hours and the AN69 hemofilter(1.2 m^2) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993. 9 ±983. 0 ml/h, the blood flow rate was 250 -300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant.Results CWH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICUmortality of 23. 1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE Ⅱ score before CVVH was 15.2 ± 6. 5, but decreased significantly to 8. 1±5.3, 7. 5±4.9 and 8. 0 ±5.2 at the 24th, 48th and 72nd hour after CWH, respectively (P<0. 01 ). Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CWH levels 12 hours later.After CWH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1β and TNFα was 0.33 ± 0. 11 and 0. 16 ±0. 08.Conclusion CWH offered therapeutic options for ANP and was well tolerated resulting in clearanceof IL-1β and TNFα CWH at earlv staaes of SAP mav contribute to the improvement of outcome.