1.Introduction
Acute pancreatitis(AP), an inflammatory disorder of the pancreas, is the leading cause of admission to hospital for gastrointestinal disorders in many countries1, it is one of the common acute abdominal diseases. The incidence rate of acute pancreatitis is rising globally, which sharp increasing its burden on healthcare services2.Acute pancreatitis is an inflammatory response of pancreatic tissue to self-digestion, edema, bleeding and even necrosis after pancreatin activation in the pancreas due to various etiologies. The most likely causes of pancreatitis are Alcoholism, gallstones3.Because the severity of acute pancreatitis is different, clinical acute pancreatitis is divided into three types: mild, medium and severe, while according to the type of inflammation, acute pancreatitis can be divided into interstitial edema pancreatitis or necrotizing pancreatitis.4About 80% to 85% of patients will develop only mild acute pancreatitis, while about 15% to 20% of patients will develop severe acute pancreatitis with severe organ failure and local complications, which may even lead to death5.
The main clinical manifestations of acute pancreatitis are abdominal pain, nausea, vomiting, high fever, jaundice, peritoneal irritation and so on6. AP is a digestive system disease which caused by a variety of factors and characterized by acute inflammation of the pancreas and histologically acinar cell destruction. Two of the following three criterias can be defined as acute pancreatitis: abdominal pain, serum amylase and lipase thresholds typically three times the upper limit, and imaging criteria (computed tomography, magnetic resonance imaging, ultrasound)7. Lysosome function is disturbed, a series of digestive enzymes are activated abnormally, leading to digestive damage and local inflammation. It has been demonstrated that acini damage can stimulate inflammation in the pancreatic parenchyma due to the pancreas’s own digestive process(like filtration of neutrophils and macrophages, and release of cytokines, tumor necrosis factor, and interleukin-1,6, and 8)8. Therefore, intervention for acute pancreatitis is very important. The conventional treatment of acute pancreatitis is mainly to reduce the secretion of pancreatic fluid and reduce the pancreas’s self-digestion as much as possible. This usually involve fasting and water prohibition, gastrointestinal decompression, use of somatostatin and its analogs, thus inhibition of gastric acid secretion. Fluid resuscitation, enteral nutrition, and antibiotics to treat infections, suppress inflammation, and prevent organ failure9. However, some evidence suggest that prophylactic antibiotic used in patients with acute pancreatitis is not associated with significant reductions in mortality or morbidity recently. Therefore, routine prophylactic antibiotics are no longer recommended for all patients with acute pancreatitis10. Antibiotics are the first choice for the treatment of infectious severe acute pancreatitis. Whereas, diagnosis is a challenge because the clinical presentation is indistinguishable from other infectious complications or inflammatory states associated with acute pancreatitis. How to choose more specific antibiotics for different patients has also become one of the difficult problems. With the development of science and technology, the continuous renal replacement therapy (CRRT) become one of the new methods of renal replacement therapy. Since it has to maintain electrolyte balance, regulate acid-base degree of fluid and waste from the blood metabolic, inflammatory mediator and endotoxin, thereby protect endothelial cells, help regulate the body’s immune function, it not only can be widely used in acute and chronic renal failure, can also play an important role in the treatment of AP11.Compared with conventional treatment, does CRRT have a more beneficial effect on the treatment of patients? Does it reduce inflammation more in patients with acute pancreatitis? What about the function of liver and kidney of patient and viscera maintenance respect? Up to now, no one has evaluated CRRT versus conventional treatment for acute pancreatitis in these areas. Through this study, the effect of CRRT on the treatment effect and prognosis of AP was systematically evaluated to explore whether CRRT was a necessary way to treat AP and provide evidence-based medicine basis for the treatment of AP.