Effects Of Hydroxyethyl Starch And Abdominal Minimally Invasive Peritoneal Drainage In Intra-abdominal Pressure And Inflammatory Cytokines In Early Stage Of Severe Acute Pancreatitis

Objective:To investigate the effect of hydroxyethyl starch (HES)130/0.4on intra-abdominal hypertention (IAH), inflammatory cytokines and renal function in early stage of severe acute pancreatitis (SAP).Methods:Clinical database of SAP patients from Oct2007to Nov2008were analyzed retrospectively. The pacients with IAH (intra-abdominal pressure [IAP]>12mmHg) were selected for analysis. The patients were devided into study group and control group based on whether combined hydroxyethyl starch130/0.4for fluid resuscitation or not. Then we compared the defference between IAP, APACHE II score, inflammatory cytocine (IL-1, IL-8and TNF-α), BUN and Cr.Results:A total of55patients were included in the study.24patients received colloid plus hydroxyethyl starch130/0.4for fluid resuscitation(study group) and31patients received only colloid(control group). The baseline data were comparable. IAP was lower in research group than that in control group at day3and day5to day8(p<0.05), The decline of daily IAP to baseline (ΔIAP)in research group was significantly higher than in research group from day3to day8(P<0.05). the decline of daily APACHE II score to baseline(Δ APACHE II score) in research group were significantly higher from day5(p<0.05). The IL-1and IL-8level was lower in research group at day8(p<0.05), and The IL-4level was lower in research group at day4and day8(P<0.05). The BUN and Cr level were comparable in the1,4, and8day after admssion between study group and control group.Conclusions:Early fluid resuscitation with HES130/0.4relieves IAH, reduces APACHE II score and inflammatory cytokine, and The BUN and Cr level were comparable between two groups. Objective:To investigate the role of minimally invasive peritoneal drainage in early stage of severe acute pancreatitis (SAP).Methods:A cohort of17consecutive patients with SAP who underwent minimally invasive peritoneal drainage composed drainage group.17patients with SAP who did not undergo minimally invasive peritoneal drainage were selected randomly to pair with patients in drainage group on IAP and composed control group. The IAP, central venous pressure (CVP), heart rate (HR), APACHE Ⅱ Score, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6and IL-8were compared between the two groups.Results:The median interval between the onset of SAP and drainage of the patients in the drainage group was1(0-6) day, and the median duration was5(2-8) days with average total drainage volume of2871±2210ml. The IAP and CVP in drainage group decreased immediately (2.14±2.09mmHg,1.13±3.14cmH2O) after the drainage, while decreased slowly in the subsequent days. HR and APACHE Ⅱ Score decreased slower in drainage group without significant difference. The hs-CRP, TNF-α, IL-1, IL-6decreased faster or increased slower in drainage group.Conclusions:This study showed the role of minimally invasive peritoneal drainage on decrease of IAP and mediation of inflammatory cytokines in early stage of SAP. It may benefit patients with SAP in early stage on decrease of IAP and inflammatory response modulation especially when intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) was complicated. Its exact roles need further randomize controlled trials. Objective:To investigate the relationship between intra-abdominal pressure (IAP) and central venous pressure (CVP) in the early phase of severe acute pancreatitis (SAP) patients.Methods:The data of116patients with SAP admitted to our centre were analyzed retrospectively. All the patients admitted within3days after the onset of the disease and the relationship between intra-abdominal pressure (IAP) and central venous pressure (CVP) in the first24hours were analyzed. All analyses were performed using Empowerstats and R (http://www.R-project.org). A value of p<0.05was considered statistically significant. We first splited CVP into three groups to present the general condition of the patient. A scatter plot of CVP (cmH2O) by IAP (mmHg) was created, and then a generalized additive model using spline smoothing function was applied to examine the relationship between CVP and IAP. The turning points connecting the piecewise lines were determined using trial and error, including selection of turning points along a pre-defined interval and choosing the turning point that gave the maximum model likelihood. Finally we applied multiple regression analyses to estimate the correlation coefficient (and95%CI) between IAP and CVP, with an adjustment for potential confounders.Results:In the first24-hours after admission, the relationship between CVP and IAP is not a simple linear correlation. CVP fluctuates and increases with increasing IAP, and then decreased. Similar trends was also found in the subgroup. CVP fluctuates and increases with increasing IAP up to15.7mmHg. When IAP>15.7mmHg, CVP decreased with IAP’s increasing. Threshold effect analysis indicated CVP fluctuates and increases with increasing IAP up to15.7mmHg (β:0.21,95%CI:[0.00,0.41], P=0.054). When IAP>15.7mmHg, CVP decreased with IAP’s increasing (β:2.12,95%CI:[-2.67,-1.57], P<0.001). After adjusted abdominal perfusion pressure (APP) and mean arterial pressure (MAP) level, similar distribution also presented.Conclusions:In the early phase of severe acute pancreatitis (SAP), CVP fluctuates and increases with increasing LAP up to15.7mmHg. When IAP>15.7mmHg, CVP decreased with IAP’s increasing.