The Clinical Research And The Effect On Immune Function Of Different Volume Hemofiltration On Severe Acute Pancreatitis

Objective To investigate the curative effect and the effect on immune function of different volume hemofiltration on severe acute pancreatitis with contrast.Methods 19 patients with SAP were divided into two groups with random. 9 patients accepted CVVH, the others accepted CHVHF, and all patients with conventional therapy. The first therapy time was 48 hours, change filter per 24 hours, adjusted therapy time post-48 hours. The HI,MAP,BR,BT, and the APACHE II, blood biochemical indicator,arterial blood gas analysis were recorded or measured in the treatment .,pre-treatment and post-treatment, the inflammatory cytokines were detected with ELISA, T lymphocyte subgroup and HLA-DR were detected with flow cytometry per 12 hours.Results The hemodynamics of all patients was stabilize, and without serious adverse effect. HR,BR,BT were significant degraded, the clinical symptom was retrieved with different degree, CHVHF group surpassed CWH group. The APACHE II were degraded, but CVVH group without significant difference, CHVHF group with statistical significance (P<0.05), there was statistical significance in two groups (P<0.05). Serum sodium,kalium,chlorine were not obviously change, serum calcium,magnesium were step up post-treatment. ALT,Scr,BUN,TBIL were significant degraded(P<0.05), CHVHF group was surpass CVVH group. Acidosis,hypoxemia were retrieved with different degree, CHVHF group surpassed CVVH group. Compared with pre-treatment, TNF-α,IL-6,IL-8 were both degraded as proinflammatory cytokines, but in CVVH group without significant difference, CHVHF group with statistical significance, there was statistical significance in two groups (P<0. 05). IL-10 as antiinflammatory cytokine was not difference compared with pre-treatment in two groups. HLA-DR expression was advancing with treatment, there was not difference compared in CVVH group. In CHVHF group, HLA-DR expression was advanced significant to 24 hour(P<00 05), and extremely significant post-treatment (P<0. 01). The cell percent of CD₄⁺,CD₈⁺ and the ratio of CD₄⁺/CD₈⁺ were not all significant difference in CVVH group post-treatment, in CHVHF group the cell percent CD₄⁺ the ratio of CD₄V CD₈⁺ were set up with significant difference (P<0.05) and the cell percent of CD₈⁺ without significant difference. The mortality in CWH group was 33.3%(3/9), in CWH group was 10%(l/10). The mortality was compared in two groups, CHVHF group surpassed CVVH group. There was not statistical significance (P=0. 3034>0.05).Conclusion The CBP therapy can cut down BT,HR and BR, improve abdominal pain,abdominal distention clinical symptom, retrieve acid-base imbalance,electrolyte disturbances, control azotemia, stabilize internal environment in SAP patients earlier. The mechanism may be CBP could clean TNF-α,IL-6,IL-8 mediators of inflammation, block inflammatory reaction. Compared CVVH with CHVHF, the curative effect of CHVHF was surpass those of CVVH, the reason may be CHVHF could clean mediators of inflammation utilitier than CVVH, improve SAP patients immune dysfunction, restitution immune system condition.Significance CHVHF mechanism of action is not confine to clean cytokine, the important effect is accommodate immune malfunction and re-stablish immune system condition. We ought to elect CHVHF in the clinic to improve prognosis.