Effects of continuous high-volume hemofiltration on experimental severe acute pancreatitis in pigs.
OBJECTIVE
To compare the effects of different doses of hemofiltration on severe acute pancreatitis (SAP) in pigs.


METHODS
The animal model of SAP was produced by intraductal injection of sodium taurocholate and trypsin. Animals in group 1 served as SAP control. Animals in group 2 received (20 mL/kg per hour) continuous low-volume hemofiltration (LVHF), and animals in group 3 received (100 mL/kg per hour) continuous high-volume hemofiltration (HVHF) immediately after the induction of SAP. After the instrumentation of the animals by arterial and Swan-Ganz catheters, hemodynamic indexes were monitored intermittently at different times. The rectal temperature and the concentration of amylase and cytokines in serum were measured at the same time.


RESULTS
The survival time of HVHF group was significantly prolonged (P < 0.01). The initial elevation of body temperature and the hypothermia in the late course of experiments were significantly ameliorated by HVHF (P < 0.01). Six hours after the induction of pancreatitis, the urine output of animals in HVHF group was obviously higher than that in control group (P < 0.05), which stayed behind 36 hours later (P < 0.05). The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by HVHF (P < 0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in CI, an attenuated decrease in systemic vascular resistance index. Plasma amylases in the HVHF group were significantly lower than those in control and LVHF groups (P < 0.01). The serum concentrations of cytokines such as tumor necrosis factor alpha (TNF-alpha), interleukin (IL) 6, and IL-10 all decreased significantly in treatment groups (P < 0.01), and those of HVHF group were less significant than the HVHF group (P < 0.01).


CONCLUSIONS
The HVHF was associated with a better hemodynamic profile, a less hyperkinetic state, and more prolonged survival than that of LVHF, which may result from the HVHF that can remove the inflammatory cytokines more efficiently.
Li
Weiqin
W
Surgical Intensive Care Unit, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jiangsu Province, China.
Yan
Xiaowen
X
Wang
Hao
H
Zhang
Zhenhuan
Z
Yu
Wenkui
W
Ji
Daxi
D
Gong
Dehua
D
Quan
Zhufu
Z
Li
Jieshou
J
D000208:Acute Disease; D000681:Amylases / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D001831:Body Temperature; D002302:Cardiac Output; D002496:Central Venous Pressure; D016207:Cytokines / Q000097:blood; D006339:Heart Rate; D006440:Hemofiltration / Q000379:methods*; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008049:Lipase / Q000097:blood; D010195:Pancreatitis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D011669:Pulmonary Wedge Pressure; D012720:Severity of Illness Index; D015996:Survival Rate; D013552:Swine; D014556:Urine; D014655:Vascular Resistance
D016207:Cytokines; D008049:Lipase; D000681:Amylases