Effect of plasma exchange combined with continuous renal replacement therapy in patients with severe acute pancreatitis

doi:10.3877/cma.j.issn.1674-6880.2019.05.003

Abstract

Abstract:

Objective

To investigate the effect of early plasma exchange combined with continuous renal replacement therapy (CRRT) in the treatment of patients with severe acute pancreatitis (SAP).

Methods

A total of 135 SAP patients admitted to the ICU and Emergency ICU of Affiliated Hospital of Qingdao University between March 2016 and September 2018 were randomly divided into the routine group (69 cases) and plasma exchange group (66 cases) according to their hospital numbers. Patients in the routine group were treated with CRRT immediately after admission for 72 h, and patients in the plasma exchange group were treated with plasma exchange and CRRT for 72 h. The therapeutic effect, hospitalization time, serological indicators, incidence of complications, and average filter life were compared between the two groups.

Results

The therapeutic effect was significantly better in the plasma exchange group than in the routine group [87.88% (58/66) vs. 65.22% (45/69), χ²= 9.579, P= 0.002]. The hospitalization time was significantly shorter in the plasma exchange group than in the routine group [(11.4 ± 1.5) d vs. (21.3 ± 2.8) d, t= 2.979, P= 0.004]. The levels of serum amylase [(103 ± 24) U/L vs. (267 ± 60) U/L, t= 2.419, P= 0.021], C-reactive protein [(51 ± 8) mg/L vs. (129 ± 19) mg/L, t= 4.574, P < 0.001] and white blood cell [(8.9 ± 0.5) × 10⁹/L vs. (11.5 ± 1.0) × 10⁹/L, t= 2.059, P= 0.046] after treatment and the incidence of acute respiratory distress syndrome [6.06% (4/66) vs. 34.78% (24/69), χ²= 16.930, P < 0.001], multiple organ dysfunction syndrome [7.58% (5/66) vs. 30.43% (21/69), χ²= 11.340, P < 0.001] and pancreatic encephalopathy [9.09% (6/66) vs. 39.13% (27/69), χ²= 16.480, P= 0.002] in the plasma exchange group were significantly lower than those in the routine group. The average filter life of the plasma exchange group was significantly longer than that of the routine group [(24.7 ± 2.3) h vs. (12.1 ± 1.4) h, t= 4.829, P < 0.001].

Conclusions

Plasma exchange combined with CRRT is effective in the treatment of SAP and worthy of clinical application. It can significantly improve patients' clinical symptoms and serum test results, reduce the incidence of complications and prolong the filter life, thereby improving the quality of extracorporeal circulation therapy.

Key words: Severe acute pancreatitis, Plasma Exchange, Continuous renal replacement therapy

Peipei Xie, Fuguo Yang, Xinting Pan, Chenglin Zhang, Jingyu Song. Effect of plasma exchange combined with continuous renal replacement therapy in patients with severe acute pancreatitis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(05): 301-305.

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References 22

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组别	例数	性别比（例，男/女）	年龄（岁）	体温（℃）	心率（次/min）	呼吸（次/min）	平均动脉压（mmHg）
常规组	69	38/31	48.6 ± 1.8	37.63 ± 0.08	99.6 ± 2.4	27.8 ± 0.9	70.1 ± 1.8
血浆置换组	66	37/29	50.1 ± 1.9	37.73 ± 0.10	98.8 ± 2.6	28.1 ± 0.8	71.4 ± 2.0
t/χ²值	?	0.013	0.591	0.732	0.216	0.289	0.513
P值	?	0.908	0.556	0.465	0.830	0.773	0.609
组别	例数	发病原因[例（%）]
组别	例数	酒精性	高脂血症性	胆源性	经内镜逆行性胰胆管造影术后	其他
常规组	69	19（27.54）	34（49.28）	11（15.94）	2（2.90）	3（4.34）
血浆置换组	66	18（27.27）	32（48.48）	10（15.15）	3（4.55）	3（4.55）
t/χ²值	?	0.001	0.008	0.016	0.257	0.003
P值	?	0.973	0.927	0.899	0.613	0.956

组别	例数	性别比（例，男/女）	年龄（岁）	体温（℃）	心率（次/min）	呼吸（次/min）	平均动脉压（mmHg）
常规组	69	38/31	48.6 ± 1.8	37.63 ± 0.08	99.6 ± 2.4	27.8 ± 0.9	70.1 ± 1.8
血浆置换组	66	37/29	50.1 ± 1.9	37.73 ± 0.10	98.8 ± 2.6	28.1 ± 0.8	71.4 ± 2.0
t/χ²值	?	0.013	0.591	0.732	0.216	0.289	0.513
P值	?	0.908	0.556	0.465	0.830	0.773	0.609
组别	例数	发病原因[例（%）]
组别	例数	酒精性	高脂血症性	胆源性	经内镜逆行性胰胆管造影术后	其他
常规组	69	19（27.54）	34（49.28）	11（15.94）	2（2.90）	3（4.34）
血浆置换组	66	18（27.27）	32（48.48）	10（15.15）	3（4.55）	3（4.55）
t/χ²值	?	0.001	0.008	0.016	0.257	0.003
P值	?	0.973	0.927	0.899	0.613	0.956

组别	例数	血清淀粉酶（U/L）		CRP（mg/L）		白细胞计数（× 10⁹/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规组	69	2 560 ± 555	267 ± 60	209 ± 18	129 ± 19	20.9 ± 1.0	11.5 ± 1.0
血浆置换组	66	2 605 ± 645	103 ± 24	215 ± 19	51 ± 8	20.1 ± 1.2	8.9 ± 0.5
t值	?	0.053	2.419	0.209	4.574	0.553	2.059
P值	?	0.958	0.021	0.835	<0.001	0.581	0.046

组别	例数	血清淀粉酶（U/L）		CRP（mg/L）		白细胞计数（× 10⁹/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规组	69	2 560 ± 555	267 ± 60	209 ± 18	129 ± 19	20.9 ± 1.0	11.5 ± 1.0
血浆置换组	66	2 605 ± 645	103 ± 24	215 ± 19	51 ± 8	20.1 ± 1.2	8.9 ± 0.5
t值	?	0.053	2.419	0.209	4.574	0.553	2.059
P值	?	0.958	0.021	0.835	<0.001	0.581	0.046

组别	例数	ARDS	MODS	胰性脑病
常规组	69	24（34.78）	21（30.43）	27（39.13）
血浆置换组	66	4（6.06）	5（7.58）	6（9.09）
χ²值	?	16.930	11.340	16.480
P值	?	<0.001	<0.001	0.002

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