Observation of the efficacy of CRRT in the treatment of severe pancreatitis / 中国基层医药

ABSTRACT

Objective To investigate the clinical efficacy of CRRT in the treatment of severe pancreatitis.Methods 120 patients with severe pancreatitis were divided into two groups according to the treatment.All the patients were given basic treatment in all groups.The Pa arterial oxygen pressure (PaO2),oxygenation index (PaO2/FiO2),and C-reactive protein (CRP) in the two groups after 72 hours of treatment were observed.The levels of blood lactate (Lac),APACHEII,tumor necrosis factor α(TNF-α),interleukin-6 (IL-6) and interleukin-1β (IL-1β) were measured before and after treatment 72 hours.A comparison of mortality and hospitalization time was observed in 28 days of treatment.Results After treatment,Lac [the control group (3.32±0.85)mmol/L,the observation group (2.55±0.65)mmol/L],APACHEII score [the control group (13.30±2.80)points,the observation group (12.01±2.60)points],CRP [the control group (24.30±2.80)mg/L,the observation group (12.33±1.60)mg/L] were significantly lower than before treatment [Lacthe control group (4.85±1.05)mmol/L,the observation group (4.90±1.02)mmol/L;APACHEII scorethe control group (16.62±2.95)points,the observation group (16.90±3.01)points;CRPthe control group (40.32±3.10)mg/L,the observation group (40.40±3.51)mg/L;the control grouptLac=1.67,P=0.004,tAPACHEII=6.32,P=0.000,tCRP=29.71,P=0.000;the observation grouptLac=15.05,P=0.005,tAPACHEII=9.52,P=0.000,tCRP=56.36,P=0.000].PaO2 [the control group (75.30±4.80)mmHg,the observation group (84.31±4.60)mmHg], PaO2/FiO2 [the control group (225.30±14.83)mmHg,the observation group (256.31±14.65)mmHg] were significantly higher than before treatment [PaO2the control group (60.32±4.15)mmHg,the observation group (60.40±4.01)mmHg;PaO2/FiO2the control group (130.39±11.15)mmHg,the observation group (130.90±11.01)mmHg;the control grouptPaO2=18.29,P=0.000,tPaO2/FiO2=39.62,P=0.000;the observation grouptPaO2=30.35,P=0.000,tPaO2/FiO2=53.01,P=0.000].Those in the observation group were significantly improved than the control group (tLac=5.574,P=0.00,tAPACHEII score=2.615,P=0.005,tPaO2=3.646,P=0.0002,tPaO2/FiO2=11.523,P=0.00,tCRP=28.751,P=0.000).After treatment,the TNF-α,IL-6 and IL-1β levels in the two groups [the control groupIL-1β (70.32±6.85)ng/mL,IL-6 (103.30±8.80)ng/mL,TNF-α (89.30±8.80) ng/mL;the observation groupIL-1β(48.55±6.62)ng/mL,IL-6(92.01±8.60)ng/mL,TNF-α(57.31±7.60)ng/mL] were significantly improved than before treatment [the control groupIL-1β(82.85±7.05)ng/mL,IL-6(173.62±9.95)ng/mL,TNF-α (105.32±9.15)ng/mL;the observation groupIL-1β(83.90±7.32)ng/mL,IL-6 (175.90±10.01)ng/mL,TNF-α (106.40±9.01)ng/mL;the control grouptIL-1β=9.66,P=0.000,tIL-6=41.01,P=0.000,tTNF-α=9.77,P=0.000;the observation grouptIL-1β=27.74,P=0.000,tIL-6=49.23,P=0.000,tTNF-α=32.26,P=0.000].And those of the observation group improved more significantly than the control group (tIL-1β=17.702,P=0.00,tIL-6=7.107,P=0.00,tTNF-α=21.311,P=0.000).The mortality rate and hospitalization time of the observation group were 18.33% and (10.97±2.92)days,which were significantly lower than those of the control group [36.67%,(13.63±3.26)days;χ2=5.058,P=0.025;t=4.708,P=0.000).Conclusion The use of CRRT in the treatment of severe pancreatitis can improve the vital signs,reduce the inflammation index,improve the serum levels of inflammatory factors and lactic acid,reduce the mortality and hospital stay.