| Objective:To investigate the therapeutic effect and clinical characteristics of continuous blood purification in the treatment of severe acute pancreatitis complicated with multiple organ dysfunction syndrome.Methods:A retrospective study was conducted on 100 patients which diagnosed with SAP complicated with MODS who were hospitalized in the First Affiliated Hospital of Kunming Medical University from December 1,2015 to November 31,2020.According to whether the continuous blood purification therapy the patients were divided into CBP group(43 cases)and control group(57 cases),and CBP group according to outcome were divided into CBP death group(14 cases)and CBP survival group(29 cases).Collecting patients’ general information,the prognosis,laboratory results and systemic complications,organ dysfunction syndrome,APACHE II score,etc.To analyze the therapeutic effect of CBP and clinical characteristics the patients with SAP complicated with MODS.Results:1.General Information1.1 Age The age of the CBP group was 42.09±10.62 years old and that of the control group was 47.70±15.77 years old,and the difference was statistically significant(P<0.05).1.2 Gender There were 37 males(86%)and 6 females(14%)in the CBP group,and there were 37 males(77.2%)and 13 females(22.8%)in the control group,there was no difference(P>0.05).1.3 Personal history and previous history The history of smoking(52.4%),drinking(42.9%),hypertension(25.6%)and diabetes(9.3%)in the CBP group were higher than those in the control group(45.6%,33.9%,22.8%,8.8%),and the history of pancreatitis(20.9%)in the CBP group was lower than that in the control group(22.8%),there was no difference(P>0.05).1.4 Cause of the disease A total of 100 cases were studied,The causes were biliary in 29 cases(29.0%),hyperlipidemia in 25 cases(25.0%),alcohol in 23 cases(23.0%),no clear cause in 20 cases(20.0%),mixed in 3 cases(3.0%).CBP group causes of hyperlipidemia(34.9%),biliary(27.9%),alcohol(18.6%),with no clear reason(16.3%),mixed(2.3%)and control group causes of biliary(29.8%),alcohol(26.3%),with no clear reason(22.8%),hyperlipidemia(17.5%)and mixed(3.5%),there was no statistically significant difference is compared between two groups of various factors(P>0.05).2 MODS A total of 100 patients were studied,the most common organ dysfunction was gastrointestinal dysfunction(100%),followed by respiratory dysfunction(99%),liver dysfunction(62%),kidney dysfunction(46%),cardiovascular dysfunction(37%),coagulation dysfunction(26%),and central nervous dysfunction(11%).Organ dysfunction in the CBP group compared with the control group:respiratory(100%vs98.2%),kidney(55.8%vs38.6%),gastrointestinal(100%vs100%),liver(58.1%vs64.9%),central nervous system(18.6%vs5.3%),and there was no significant difference(P>0.05);cardiovascular(53,5%vs24.6%)and blood coagulation(48.8%vs8.8%),the difference was statistically significant(P<0.05).The number of multiple organ dysfunction in the CBP group was 4.00(3.00,5.00)compared with the control group 3.00(3.00,4.00),and the difference was statistically significant(P<0.05).3 APACHE II score CBP group APACHE Ⅱ score 15.00(10.00,18.50)higher than the control group(9.00,17.00),there were no statistically significant difference(P>0.05).4 Duration of hospitalization The length of hospitalization in the CBP group was 25.00(20.00,37.50)higher than that in the control group 21.00(15.00,29.00),and the difference was not statistically significant(P>0.05).5 hospitalization expenses The hospitalization cost of CBP group was 199,988.49(116266.06,347,619.78)yuan higher than that of control group,67500.00(45891.27,144596.32)yuan,and the difference was statistically significant(P<0.05).6 Outcome The number of deaths in the CBP group was 14(32.6%),compared with 4(7%)in the control group,and the difference was statistically significant(P<0.05).7 therapeutic effect7.1 CBP group Compared with before treatment and 7 days after treatment,HR,SBP,DBP,HCT,TBIL,BUN,SCR,LAC,CRP,PCT were all decreased and Ca2+was increased,with statistical significance(P<0.05).7.2 Control group HR,SBP,DBP,HCT,TBIL,BUN,SCR,LAC,CRP,PCT were all decreased before treatment and Ca2+was increased compared with before treatment,and the difference was statistically significant(P<0.05).7.3 Differences in treatment between the CBP group and the control group Differences between the CBP group and the control group were compared before and after treatment.The differences of SBP,DBP,TBIL,SCR,LAC and PCT levels in the CBP group were higher than those in the control group before and after treatment,while the differences of CRP and HR levels in the CBP group were lower than those in the control group before and after treatment,with no statistical significance(P>0.05).The difference of HCT,BUN and Ca2+levels in CBP group before and after treatment was higher than that in control group,and the difference was statistically significant(P<0.05).8 Comparison of clinical characteristics between the CBP death group and the survival group8.1 General information There were no statistically significant differences in gender between the CBP death group and the CBP survival group(P>0.05).CBP group were aged 47.36±11.39(years old)higher than that of CBP survival group 39.55±9.40(years old),APACHE Ⅱ score 16.50 13.00(13.50,21.75)higher than that of CBP survival group(7.00,15.00),CBP to onset time CBP death group is higher than 6.00(4.00,9.00)days CBP survival group 3.00(2.00,6.00),difference was statistically significant(P<0.05).8.1.1 CBP onset within 3 days of onset was compared with CBP onset 3 days after onset The mortality rate in the group that started CBP treatment within 3 days after onset of disease was 11.1%,which was significantly lower than that in the group that started CBP treatment 3 days after onset of disease,which was 48%,the difference was statistically significant(P<0.05).8.2 Systemic Complications Systemic complications of SIRS(100%vs100%),organ dysfunction(100%vs100%),IAH(28.6%vs31.0%),ACS(28.6%vs10.3%),pancreatic encephalopathy(7.1%vs0%),peritoneal effusion(92.9%vs79.3%),pleural effusion(71.4%vs75.9%)and pulmonary infection(100%vs 96.6%)were compared between the CBP death group and the CBP survival group.There was no significant difference(P>0.05).Sepsis(85.7%vs44.8%)and gastrointestinal bleeding(64.3%vs13.8%),the difference was statistically significant(P<0.05).8.3 Multiple organ dysfunction syndrome Compared with the CBP survival group,there was no significant difference in respiration(100%vs100%),kidney(71.4%vs48.3%),gastrointestinal(100%vs100%vs100%),liver(71.4%vs51.7%),blood coagulation(50.0%vs48.3%)and central nervous system(35.7%vs10.3%)between the CBP death group and the CBP survival group(P>0.05).Cardiovascular(85.7%vs37.9%),the difference was statistically significant(P<0.05).The number of organ dysfunction in the CBP death group was 5.00(4.00,6.00)higher than that in the CBP survival group(4.00,5.00),and the difference was statistically significant(P<0.05).Conclusion:1.CBP treatment can significantly reduce the levels of HCT and BUN in patients with SAP complicated with MODS,increase the level of Ca2+,quickly remove metabolic wastes,improve renal function,and regulate the electrolyte balance of the body.2.For patients with SAP complicated with MODS with very poor prognosis and large number of organ dysfunction,CBP treatment cannot reduce their mortality.3.The time between the start of CBP treatment and the onset of SAP may affect the efficacy of CBP treatment.The efficacy of CBP treatment started within 3 days after the onset of SAP is better than 3 days after the onset of SAP.4.In patients with SAP complicated with MODS,the most common organ dysfunction was gastrointestinal dysfunction,followed by respiratory,liver,kidney,cardiovascular,blood coagulation and central nervous system.5.APACHE II score at admission,age,sepsis,gastrointestinal bleeding,cardiovascular dysfunction,The number of organ systems with dysfunction and the time between CBP treatment and the onset of CBP were the factors affecting the prognosis of patients with SAP complicated with MODS under CBP treatment. |
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