AIM： To investigate whether continuous veno-venous hemofiltration （CVVH） in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time o...AIM： To investigate whether continuous veno-venous hemofiltration （CVVH） in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis. METHODS： Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain （late CVVH, n= 10）. Group 3 underwent high-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 4 received high-volume CVVH after 96 h of theonset of abdominal pain （late CVVH, n = 9）. CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CVVH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific ELISA. The Solartron 1 255 B frequency response analyzer （British） was used to observe the resistance of filter membrane. RESULTS： The survival rate had a significant difference （94.44% vs68.42%, P〈0.01） high-volume and low-volume CVVH patients. The survival rate had also a significant difference （88.89% vs 73.68%, P〈0.05） between early and late CVVH patients. The hemodynamic deterioration （MAP, HR, CVP） was less severe in groups 4 and 1 bhan that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed, serum TNF-α concentrations had a negative correlationwith resistance （r： -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2; -0.88, -0.92, and -0.82, respectively in group 3; -0.84, -0.87, and -0.79, respectively in group 4）. The decreasing extent of TNF-α, IL-1β and IL-6 was significantly different between group 3 and group I （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 4 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 1 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.05）, and between group 3 and group 4 （TNF-α P〈0.01, IL-1β P〈0.01, IL-6 P〈0.05）, respectively during CVVH period. The decreasing extent of TNF-α and IL-1β was also significantly different between survival patients and dead patients （TNF-α P〈0.05, IL-1β P〈0.05）. In survival patients, serum concentration of TNF-α and IL-1β decreased more significantly than that in dead patients. CONCLUSION： High-volume and early CWH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more effidently than low-volume CVVH. The survival rate is related to the decrease extent of TNF-α and IL-1β. The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated.展开更多
AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk datab...AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.展开更多
基金Supported by the Natural Science Foundation of Shaanxi Province,No. 2002C257
文摘AIM： To investigate whether continuous veno-venous hemofiltration （CVVH） in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis. METHODS： Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain （late CVVH, n= 10）. Group 3 underwent high-volume CVVH within 48 h of the onset of abdominal pain （early CVVH, n = 9）. Group 4 received high-volume CVVH after 96 h of theonset of abdominal pain （late CVVH, n = 9）. CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CVVH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific ELISA. The Solartron 1 255 B frequency response analyzer （British） was used to observe the resistance of filter membrane. RESULTS： The survival rate had a significant difference （94.44% vs68.42%, P〈0.01） high-volume and low-volume CVVH patients. The survival rate had also a significant difference （88.89% vs 73.68%, P〈0.05） between early and late CVVH patients. The hemodynamic deterioration （MAP, HR, CVP） was less severe in groups 4 and 1 bhan that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed, serum TNF-α concentrations had a negative correlationwith resistance （r： -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2; -0.88, -0.92, and -0.82, respectively in group 3; -0.84, -0.87, and -0.79, respectively in group 4）. The decreasing extent of TNF-α, IL-1β and IL-6 was significantly different between group 3 and group I （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 4 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.01）, between group 1 and group 2 （TNF-α P〈0.05, IL-1β P〈0.05, IL-6 P〈0.05）, and between group 3 and group 4 （TNF-α P〈0.01, IL-1β P〈0.01, IL-6 P〈0.05）, respectively during CVVH period. The decreasing extent of TNF-α and IL-1β was also significantly different between survival patients and dead patients （TNF-α P〈0.05, IL-1β P〈0.05）. In survival patients, serum concentration of TNF-α and IL-1β decreased more significantly than that in dead patients. CONCLUSION： High-volume and early CWH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more effidently than low-volume CVVH. The survival rate is related to the decrease extent of TNF-α and IL-1β. The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated.
基金Supported by The National Natural Science Foundation of China, No.30500684 and Clinical Research Foundation for Residency Granted by the Cooperative Project of West China Hospital and Daiichi Pharmaceutical Co. Ltd., the level Ⅰ
文摘AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.
