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Clinical observation of peritoneal dialysis in treating severe pancreatitis
2015, 14 (02):
100-104.
doi: 10.3969/j.issn.1671-4091.2015.02.00
【Abstract】 Objectives To evaluate the efficacy of peritoneal dialysis (PD) in the treatment of severe acute pancreatitis (SAP). Methods Thirty-six SAP patients treated in our hospital from January 2004 to December 2013 were randomly divided into two groups, PD group (n=21) in which patients were treated with PD, and non-PD group (control group, n=15) in which patients were treated with drugs or surgery. The relief time of abdominal pain and abdominal distension, the time of respiration without mechanical ventilation, the recovery time of serum amylase and urine amylase levels, scores of Balthazar CT and APACHE Ⅱ, changes of inflammatory cytokines including IL-6, PCT and CRP after treatment, length and expense of hospitalization, and recovery rate were compared between the 2 groups. Results In PD group, the relief time of abdominal pain and abdominal distension, the time of independent respiration without mechanical ventilation, and the recovery time of serum amylase and urine amylase were significantly lower than those in control group (16.08±4.32 days vs. 30.16±14.33 days, t=4.261, P=0.0002 for the relief time of abdominal pain and abdominal distension; 8.50±2.65 days vs. 18.66±6.56 days, t=6.429, P=0.0001, for the time of independent respiration without mechanical ventilation; 13.5±5.93 days vs. 25.68±11.36 days, t=4.193, P=0.0002, for serum amylase; 13.92±6.96 days vs. 28.77±12.67 days, t=4.516, P= 0.0001, for urine amylase); Balthazar CT scores after the treatment for 7 and 14 days were significantly lower than those in control group (5.33±0.67 vs. 7.95±0.53, t= 12.577, P= 0.0002, after treatment for 7 days; 2.08±0.16 vs. 7.19±0.32, t=63.188, P=0.0001, after the treatment for 14 days); APACHE Ⅱ scores after the treatment for 1, 3, 5, and 7 days were also significantly lower than those in control group (8.98±2.95 vs. 13.05±3.56, t=3.744, P= 0.0007, after the treatment for one day; 7.06±1.84 vs. 12.44±3.06, t=6.5813, P= 0.0001, after the treatment for 3 days; 5.09±1.06 vs. 10.98±2.73, t= 9.0215, P= 0.0001, after the treatment for 5 days; 3.16±0.74 vs. 9.18±1.96, t=12.9054, P= 0.0001, after the treatment for 7 days); Levels of IL-6, PCT, and CRP after the treatment for 1, 3 and 7 days were significantly lower than those in control group (122.02±89.86 ng/L vs. 286.47±238.62 ng/L, t=2.897, P= 0.0065, for IL-6 after the treatment for one day; 109.86±78.05 ng/L vs. 254.83±210.26 ng/L, t=2.905, P=0.0064, for IL-6 after 3 days; 44.24±18.43 ng/L vs. 186.54±145.27 ng/L, t=4.464, P= 0.0001, for IL-6 after 7 days; 11.00±6.22 ng/L vs. 18.86±12.19ng/L, t=2.5376, P=0.0159, for PCT after the treatment for one day; 5.56±3.12 ng/L vs. 15.89±9.88 ng/L, t=4.5092, P=0.0001, for PCT after the treatment for 3 days; 1.65±0.93 ng/Lvs. 10.39±5.77 ng/L, t=6.8565, P= 0.0001, for PCT after the treatment for 7 days; 96.39±44.13 ng/L vs. 120.14±44.53 ng/L, t=2.068, P=0.022, for CRP after the treatment for one day; 82.14±38.98 ng/L vs. 108.82±41.71 ng/L, t=2.626, P=0.0374, for CRP after the treatment for 3 days; 46.90±22.24 ng/L vs. 89.45±40.58 ng/L, t=4.0433, P= 0.0003, for CRP after the treatment for 7 days); the length and expenses of hospitalization were significantly less than those in the control group (33.42±12.27 days vs. 58.16±14.38 days, t=5.5526, P=0.0001, for hospitalization days; 13.71±4.93 x 104 yuan vs. 28.54±15.26 x 104 yuan, t=4.1791, P=0.0002, for expenses during hospitalization); mortality and complication rates were significantly lower than those in control group (14.29% vs. 40.00%, X2=6.722, P=0.0242, for mortality rate; 0 vs. 46.67%, X2=6.03, P=0.030, for complication rate). Conclusion PD was proven to be effective and valuable in the treatment of SAP. PD lowered the mortality and complication rate as well as the time and expenses of hospitalization, and importantly, increased the cure rate.
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