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.