Use of Plasmapheresis in the Enzymatic Phase of Severe Acute Pancreatitis

Abstract

Objective: to evaluate the efficiency of early plasmapheresis in the enzymatic phase of severe acute pancreatitis. Patient characteristics and methods. Thirteen 25-to-86-year-old patients diagnosed with severe acute pancreatitis (SAP) were examined and treated at the intensive care unit of the military hospital (Sergiev Posad) in 2011—2012. The patients underwent comprehensive clinical, laboratory, and instrumental examinations. Their clinical and laboratory parameters were analyzed at admission, before and after extracorporeal detoxification. The exfused plasma level of pancreatic enzymes was studied. The admission patient status was assessed using the APACHE II; the severity of the disease was evaluated employing the Glasgow and Ranson pancreatic scales; the Murray scale was used to estimate the degree of acute lung lesion. During the prospective study, there were 2 patient groups: 1) 7 patients who underwent extracorporeal detoxification in early-stage disease (on days 1—2); 2) 6 patients received infusion therapy with forced diuresis elements as detoxification measures (a comparison group). The incidence of acute respiratory distress syndrome (ARDS), pancreatic tissue destruction, and pyoseptic complications and intensive care unit stay and hospital length of stay, and mortality were comparatively analyzed. Results. The investigation demonstrated that there were reductions in the incidence of ARDS by 35.7%, pancreatic destruction by 35.7%, and pyoseptic complications by 16.7% and in the intensive care unit stay and hospital length of stay by 42.9 and 31.2%, respectively, and in mortality rates by 16.7% in Group 1 compared to Group 2. Conclusion. The use of plasmapheresis to treat early-stage SAP assists in reducing the magnitude of enzymatic toxemia due to the direct elimination of pancreatic enzymes from systemic circulation. This sanogenic effect can offset the aggressive effect of hyper-enzymia and hence prevent ARDS even in severe baseline disease. Early plasmapheresis allows the results of intensive therapy for SAP to be improved. Key words: severe acute pancreatitis, acute respiratory distress syndrome, plasmapheresis.