Basic Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2005; 11(1): 127-131
Published online Jan 7, 2005. doi: 10.3748/wjg.v11.i1.127
Amelioration of hemodynamics and oxygen metabolism by continuous venovenous hemofiltration in experimental porcine pancreatitis
Hao Wang, Zhen-Huan Zhang, Xiao-Wen Yan, Wei-Qin Li, Da-Xi Ji, Zhu-Fu Quan, De-Hua Gong, Ning Li, Jie-Shou Li
Hao Wang, Zhen-Huan Zhang, Xiao-Wen Yan, Wei-Qin Li, Zhu-Fu Quan, Ning Li, Jie-Shou Li, Department of Nephrology, Nanjing University School of Medicine, Nanjing 210093, Jiangsu Province, China
Da-Xi Ji, De-Hua Gong, Department of Surgery, Nanjing University School of Medicine, Nanjing 210093, Jiangsu Province, China
Author contributions: All authors contributed equally to the work.
Supported by the Social Development Foundation of Jiangsu Province, No. BS2000051
Correspondence to: Dr. Wei-Qin Li, Department of Surgery, Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. liweiqin@jlonline.com
Telephone: +86-25-3685194 Fax: +86-25-4803956
Received: March 6, 2004
Revised: March 8, 2004
Accepted: April 29, 2004
Published online: January 7, 2005
Abstract

AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP).

METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg.h)], and group 3 receiving a high-volume CVVH [100 (mL/kg.h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study.

RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs 116.3±7.8 kPa, P<0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio.

CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.

Keywords: Pancreatitis; Continuous venovenous hemofiltration; Hemodynamics; Oxygen metabolism