Effect of CRRT combined with abdominal drainage on severe acute pancreatitis complicated with IAH/ACS

doi:10.3969/j.issn.1002-1949.2015.10.004

Abstract：Objective To evaluation the effect of continuous renal replacement therapy ( CRRT) combined with abdominal drainage on severe acute pancreatitis ( SAP ) complicated with intra-abdominal hypertension/abdominal compartment syndrome ( IAH/ACS ) .Methods Eighty -four SAP patients admitted our department and finished basal treatment from January 2014 to April 2015 were randomly divided into four groups , with 21 cases in each group .Group A: treated with the abdominal drainage; group B: treated with intermittent CRRT; group C: treated with intermittent CRRT+drainage;group D:not treat with CRRT or drainage .Clinical data were collected among all the groups, including APACHEⅡ score, Balthazar CT integral, abdominal pressure, blood and ascites amylase, IL-6, IL -8, abdominal infection , operation conditions , 28 days of intraperitoneal local complications.Results The APACHEⅡ scores in group C on 3 d, 7 d, 14 d were significant lower than those in group A, B and D, respectively (P<0.05), and the APACHEⅡ scores in all groups were significant lower than those before treatment (P<0.05).Abdominal pressure in group C on 7 d, 14 d was significant lower than that in group A , B and D, respectively (P<0.05);abdominal pressure in every group reached the peak at time of 7 d, and was significant higher than those before treatment , 3 d, 14 d of treatment (P<0.05).Balthazar CT integral in group C at time of 7 d, 14 d was significant lower than that in group A, B and D, respectively (P<0.05);Balthazar CT integral in group C at time of 7 d was significant difference than that before treatment (P<0.05); Balthazar CT integral in each group at time of 14 d was significant lower than that before treatment (P<0.05).The blood, ascites amylase, IL-6, IL-8 in group C at time of 7 d, 14 d were significant lower than those in group A , B and D, respectively (P<0.05);these indexes in each group were significantly lower than those before treatment (P<0.05);IL-6 and IL-8 in ascites at the same time point were significant higher than those in blood ( P<0.05 ) .Abdominal cavity infection and 28 days pancreatic local complications in group C were significantly different compared with those in group A and D ( P<0 .05 ) .Conclusion CRRT combined with abdominal drainage may be more effective on reducing abdominal pressure , local inflammation, abdominal cavity infection and pancreatic local complications with SAP .