Clinical analysis of blood purification in the treatment of 102 patients with moderately severe acute pancreatitis and severe acute pancreatitis / 中华胰腺病杂志

ABSTRACT

Objective:To analyze the efficacy of blood purification (BP) in the treatment of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).Methods:The clinical data of 102 patients of MSAP and SAP in Changhai Hospital affiliated with Navy Medical University from December 2015 to March 2019 were retrospectively analyzed. According to the treatment method and prognostic outcome, patients were divided into control group ( n=46) and BP group ( n=56), control survival group ( n=43), and control death group ( n=3), BP survival group ( n=37) and BP death group ( n=19), respectively. Based on BP treatment duration each time, BP group was sub-divided into BP short-term group (4 h≤T<8 h, n=38) and BP long-term group (8 h≤T≤12 h, n=18). General data, laboratory findings, complications, average daily hospitalization cost, prognosis and effects of BP duration on the blood urea nitrogen improvement were recorded. Results:Compared with control survival group, BP survival group had lower levels of lactic acid, urea nitrogen and other metabolites, and SIRS duration was significantly shortened [12(7, 16) days vs 5(3, 9) days, HR=0.19, 95% CI 0.11-0.35, P<0.0001]. The clearance of urea nitrogen in BP short-term group was more obvious than BP long-term group (χ 2==4.44, P=0.035). APACHEⅡ score on admission( OR=1.33, 95% CI 1.087-1.617, P=0.005) and numbers of organ failure ( OR=3.445, 95% CI 1.426-8.323, P=0.006) were important risk factors affecting MSAP and SAP prognosis under BP therapy. For patients with extremely poor prognosis, it was still difficult for BP to reverse the progression trend and prognosis of MSAP and SAP. Conclusions:BP can effectively remove accumulated metabolites at acute stage and shorten the duration of SIRS. BP duration of 4-8 h each time may be more conducive for improving the severity of the disease.