ĐÁNH GIÁ HIỆU QUẢ THAY HUYẾT TƯƠNG BẰNG DUNG DỊCH ALBUMIN 5% TRONG ĐIỀU TRỊ VIÊM TỤY CẤP DO TĂNG TRIGLYCERIDE TẠI BỆNH VIỆN ĐẠI HỌC Y DƯỢC THÀNH PHỐ HỒ CHÍ MINH

Abstract

Introduction: hypertriglyceridemia induced acute pancreatitis is an emergency. In severe cases with complications of organ failure, the mortality rate is as high as 20-40%. The main mechanism causing acute pancreatitis due to hypertriglyceridemia is believed to be due to excessive hydrolysis of triglycerides under the action of pancreatic lipase enzyme, creating too many free fatty acids, these free fatty acids cause increase blood viscosity, causing blockage of the pancreatic vascular bed, pancreatic anemia and acute pancreatitis. The method of plasma exchange with 5% albumin solution is to quickly eliminate pathogens, prevent disease progression, and reduce severity. This study aims to evaluate the effectiveness of plasma exchange with 5% albumin solution in the treatment of hypertriglyceridemia induced acute pancreatitis. Methods: Descriptive cross-sectional study, 55 patients diagnosed with hypertriglyceridemia induced acute pancreatitis (>1000 mg/dL) treated with plasma exchange with 5% albumin solution at the Intensive Care Department. Ho Chi Minh City University of Medicine and Pharmacy Hospital from 7/2018 to 1/2023. Results: Male: 76.36%, female: 23.64%. Average age: 41.47±7.85. At admission: lipase: 993.56 ± 863.92 U/L, triglyceride (TG): 3037.63 ± 2191.53 mg/dL,  APACHE II score ≥ 8 points: 52.72%, BISAP: 1,31±0,9, patients with at least 1 organ failure accounted for 29.09%. Results of plasma exchange (PEX): symptoms of abdominal pain, nausea, and bloating decreased. Plasma volume replacing 1.5 times volume (1.5V): 84%. Only 1 cycle of PEX: 90%. After first PEX: TG from 3037.63±2191.53 to 722.3±559.83 mg/dL (76.23%), p<0,001. APACHE II ≥ 8 from 12 ± 4.72 to 7 ± 4.56 points (p < 0.001). BISAP from 1,31 ± 0,9 to 0,76 ± 0,61 (p<0,05). Pregnancy women (1,81%) did not develop any complications during the PEX. There were no adverse reactions (ADRs) associated with albumin 5%. Survival rate: 100%. Conclusions: PEX with 5% albumin solution is a safe and effective therapy in the treatment of hypertriglyceridemia induced acute pancreatitis. In this study, PEX quickly improved clinical symptoms, quickly reduced TG levels, reduced disease severity, and was safe for pregnant women. PEX with 5% albumin solution in the treatment of hypertriglyceridemia induced acute pancreatitis needs to be widely and routinely implemented in hospitals.