Effect of plasma exchange combined with continuous renal replacement therapy in patients with severe acute pancreatitis

Abstract

Objective To investigate the effect of early plasma exchange combined with continuous renal replacement therapy (CRRT) in the treatment of patients with severe acute pancreatitis (SAP). Methods A total of 135 SAP patients admitted to the ICU and Emergency ICU of Affiliated Hospital of Qingdao University between March 2016 and September 2018 were randomly divided into the routine group (69 cases) and plasma exchange group (66 cases) according to their hospital numbers. Patients in the routine group were treated with CRRT immediately after admission for 72 h, and patients in the plasma exchange group were treated with plasma exchange and CRRT for 72 h. The therapeutic effect, hospitalization time, serological indicators, incidence of complications, and average filter life were compared between the two groups. Results The therapeutic effect was significantly better in the plasma exchange group than in the routine group [87.88% (58/66) vs. 65.22% (45/69), χ2= 9.579, P= 0.002]. The hospitalization time was significantly shorter in the plasma exchange group than in the routine group [(11.4 ± 1.5) d vs. (21.3 ± 2.8) d, t= 2.979, P= 0.004]. The levels of serum amylase [(103 ± 24) U/L vs. (267 ± 60) U/L, t= 2.419, P= 0.021], C-reactive protein [(51 ± 8) mg/L vs. (129 ± 19) mg/L, t= 4.574, P < 0.001] and white blood cell [(8.9 ± 0.5) × 109/L vs. (11.5 ± 1.0) × 109/L, t= 2.059, P= 0.046] after treatment and the incidence of acute respiratory distress syndrome [6.06% (4/66) vs. 34.78% (24/69), χ2= 16.930, P < 0.001], multiple organ dysfunction syndrome [7.58% (5/66) vs. 30.43% (21/69), χ2= 11.340, P < 0.001] and pancreatic encephalopathy [9.09% (6/66) vs. 39.13% (27/69), χ2= 16.480, P= 0.002] in the plasma exchange group were significantly lower than those in the routine group. The average filter life of the plasma exchange group was significantly longer than that of the routine group [(24.7 ± 2.3) h vs. (12.1 ± 1.4) h, t= 4.829, P < 0.001]. Conclusions Plasma exchange combined with CRRT is effective in the treatment of SAP and worthy of clinical application. It can significantly improve patients' clinical symptoms and serum test results, reduce the incidence of complications and prolong the filter life, thereby improving the quality of extracorporeal circulation therapy. Key words: Severe acute pancreatitis; Plasma Exchange; Continuous renal replacement therapy