Management of Abdominal Compartment Syndrome in Severe Acute Pancreatitis Patients with Early Continuous Veno-Venous Hemofiltration

摘要

Background/Aims: The present study investigates whether early continuous veno-venous hemofiltration (CVVH) is effective for decreasing intra-abdominal pressure (IAP) and serum TNF-alpha in abdominal compartment syndrome (ACS) patients of severe acute pancreatitis (SAP), and to study the correlation between IAP and serum TNF-alpha level. Methodology: Twenty-five ACS patients of SAP were treated in the ICU and underwent CVVH. TAP and blood level of TNF-alpha were measured daily to investigate their time-course of changes and the correlation between the two parameters. Results: IAP on admission to the ICU was high (22.9 +/- 2.1 mmHg). The IAP was significantly lower (17.2 +/- 22 mmHg; p<0.01) 24 h after initiation of CVVH, and thereafter decreased rapidly. Mean the blood level of TNF-alpha was high (59.9 +/- 18.2 ng/L) on admission. However, it significantly decreased (41.1 +/- 12.8 ng/L; p<0.01) 24 h after initiation of CVVH, and subsequently decreased. There was a significant positive correlation between blood level of TNF-alpha and IAP (r=0.53, p<0.01). Conclusions: CVVH significantly decreased TAP and TNF-alpha in ACS patients of SAP. TNF-alpha was significantly correlated with TAP, suggesting that TNF-a may play an important role in the pathogenesis of ACS. Early CVVH can improve vascular permeability through elimination of cytokines such as TNF-alpha, and thereby decrease interstitial edema to lower LAP and should be applied in the early stages of ACS.