Early repeated intermittent veno-venous hemofiltration in the treatment of severe acute pancreafitis

Objective To evaluate the efficacy of early repeated intermit tent veno-venous hemofiltration (RIVVH) in the treatment of severe acute pancreatitis (SAP).Methods 70 patients were randomly divided into RIVVH group (40 cases) and control group (30 cases).The two groups' conditions were comparable.The management of these two groups was similar except for RIVVH.The vital signs,clinical presentations,serum glucose,oxygenation index,liver and kidney function,amylase,lipase,TNF-α concentration,CRP,positive rate of bacterial culture,Balthazar CT score and APACHE Ⅱ score before and after treatment,surgery rate,complication rate,mortality rate,average hospital stay and costs were compared between the two groups.Results RIVVH was started average 47.6 h after the onset of the disease.1 day later,the values of vital signs,serum glucose,oxygenation index,liver and kidney function,amylase,lipase,TNF-α concentration,CRP in treatment group were significantly better than those in the control group (P<0.05).The APACHE Ⅱ scores before treatment and 1,2,3,5,10 d later were 15.5±5.2,9.7±2.6,8.0±1.9,7.2±1.5,5.5±1.0,4.0 ±0.8,which were significantly better than those corresponding values in the control group (P<0.05).14 d after treatment,the Balthazar CT score was 5.1±1.1 in treatment group,which was significantly lower than that 6.8±1.3 in the control group (P<0.001) and lower than that 8.0±1.8 before RIVVH (P<0.001).The normalization time of amylase,lipase,alleviating time of abdominal pain and bloating,positive rate of bacterial culture,surgery rate,mortality rate,average hospital stay,mean medical costswere (1.3±1.0)d,(2.0±1.0)d,(38.2±29.0)d,27.5%,10%,5%,(28.2±16.3)d and (42842.18 ±27372.49) RMB,which were significantly lower than those in the control group (P<0.05 or P<0.01).The complication rate in RIVVH was lower than that in the control group (P<0.05).Conclusions Early RIVVH was effective in the treatment of SAP,and may be an option as adjuvant treatment measure. Key words: Pancreatitis; acute necrofizing; Venovenous hemofiltration; TNF-α; Randomized controlled trials