Application of plasmapheresis as an extracorporeal detoxification technique in the therapy of acute pancreatitis

Purpose of the study. Improving the treatment of patients with acute pancreatitis complicated by endogenous intoxication and septicemia by including plasmapheresis in intensive therapy.

Materials and Methods. 24 patients with acute pancreatitis, 19 - 65 years old, 17 men (70.8%) and 7 women (29.2%), treated in the ICU of the Central Hospital of Almaty were studied. Patients were divided into 2 groups: the main group (11 men and 4 women) received standard intensive therapy with plasmapheresis, the control group (5 men and 4 women) received only standard intensive therapy with forced dieresis.

Results and Discussion. At the beginning of treatment in both groups there was an increase in the levels of erythrocytes and hemoglobin, which then significantly decreased. By day 7, normalization of leukocytes was observed in the main group (9.51±1.69), while in the control group they remained elevated. Leukocytic intoxication index in the main group by day 3 decreased by 41.1%, compared to the control group. The level of total protein in the main group by 3-5 days increased by 13.4%, compared to the control group. Urea and creatinine levels in the main group normalized by day 3 (8.9±4.15 and 99.47±70.61), in the control group - remained elevated. Decrease of total bilirubin level to normal values (20.9±16.9) was recorded in the main group by day 5. In both groups, between days 3 and 5, there was a decrease in fibrinogen levels to normal. Prothrombin index was initially decreased in both groups, but by day 3 in the main group the values stabilized (75.69±5.1). In the main group there was a significant decrease in the mean APACHE II score and decrease in the degree of endotoxemia on the 2-3 day after the operation, in the control group these values were observed only by the 12th day. The percentage of fatal outcomes in the control group was 53.1%, in the main group - 10.3%.

Conclusions. In acute destructive pancreatitis complicated by surgical sepsis, marked endotoxemia is often observed, which is reflected by an increase in the leukocytic index of intoxication. In such cases, treatment should specifically focus on the elimination of endotoxemia, a key element contributing to the development of multiorgan dysfunction. The use of plasmapheresis stands out for its ability to effectively remove endotoxins from the bloodstream, thereby preventing the deterioration of multiorgan function and reducing the risk of mortality in patients suffering from this disease.

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