ĐÁNH GIÁ HIỆU QUẢ THAY HUYẾT TƯƠNG BẰNG HUYẾT TƯƠNG TƯƠI ĐÔNG LẠNH TRONG ĐIỀU TRỊ VIÊM TỤY CẤP DO TĂNG TRIGLYCERIDE MÁU TẠI BỆNH VIỆN CHỢ RẪY

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 hypertriglyceridemia induced acute pancreatitis 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 fresh frozen plasma is to quickly eliminate pathogens, prevent disease progression and reduce severity. This study aims to evaluate the effectiveness of plasma exchange with fresh frozen plasma in the treatment of hypertriglyceridemia induced acute pancreatitis. Methods: Descriptive cross-sectional study, 31 patients diagnosed with hypertriglyceridemia induced acute pancreatitis (TG>1000 mg/dL) treated with plasma exchange with fresh frozen plasma at the Intensive Care Department. Ho Chi Minh City University of Medicine and Pharmacy Hospital from 1/2019 to 6/2023. Results: Male: 70.97%, female: 29.03%. Average age: 42± 8.29 years old. At admission: lipase: 1093.42±1083.28 U/L, triglyceride (TG): 4042 ± 2450 mg/dL. CTSI: 5.93 ± 2.16 (balthazar D: 9,6%, balthazar E: 70,96%), APACHE II score ≥ 8 points were 96.77% (30/31). BISAP 2,03±1,17. Results of plasma exchange (PEX): symptoms of abdominal pain, nausea, and bloating all decreased after PEX. Plasma volume replacing 1.5 times the volume (1.5V): 87%. Number of patients with one-time PEX: 84%. Lipase from 1093.42±1083.28 U/L to 591.89±799.8 U/L. TG from 4042 ± 2450 mg/dL to 738 ± 640 mg/dL (81.74% reduction) after the first PEX. The group of patients with APACHE II ≥ 8 points from 20.8±8.6 to 12.6±7.3 after PEX (p<0.001). Pregnant women 4/31 (12.9%) did not develop any complications during PEX. Adverse drug reactions (ADR) related to fresh frozen plasma (FFP): 6.4%, mild ADR level. Survival rate: 93.55%, mortality rate: 6.45%. Conclusions: PEX with FFP is a safe and effective therapy in the treatment of hypertriglyceridemia induced acute pancreatitis. In this study, PEX quickly improved clinical symptoms, quickly reduced triglyceride levels, reduced disease severity, and was safe for pregnant women. PEX in the treatment of hypertriglyceridemia induced acute pancreatitis needs to be widely and routinely implemented in hospitals.