重症急性胰腺炎患者高容量连续性静脉-静脉血液净化治疗时间段选择的临床观察  

The time selection of high volume continuous veno-venous hemofiltration in the treatment of severe acute pancreatitis

作　　者：赵灵[1] 覃铁和[2] 沈东波[3] 李永波[1] 楚磊[1] 侯玉宇[1] 

机构地区：[1]暨南大学医学院第三附属医院外科ICU,广东珠海519000 [2]广东省人民医院综合ICU [3]暨南大学医学院第三附属医院血透室

出　　处：《中国医师杂志》2006年第7期892-894,共3页Journal of Chinese Physician

摘　　要：目的 研究重症急性胰腺炎患者高容量连续性静脉．静脉血液净化治疗（HV-CVVH）时间段的选择。方法 24例重症急性胰腺炎患者随机分为3组：HV-CVVH治疗8h组、治疗16h组和治疗24h组，连用5-10d。观察3组治愈率及治疗前、后血液TNF-α、IL-1、IL-6水平和APACHEII评分的变化。结果 HV-CVVH治疗后患者血流动力学参数明显改善，APACHEII评分降低，HV-CVVH治疗8h组、16h组、24h组于治疗8h后3组TNF-α，IL-1，IL-6血液浓度达最低点，之后浓度逐渐上升，于下次治疗前3组血浓度水平接近；3组间的APACHEII评分变化及治愈率差异无统计学意义（P〉0．05）。结论 HV-CVVH对重症急性胰腺炎治疗效果明显，符合血滤指征的患者每日8h血滤与更长时间血滤结果差异无统计学意义（P〉0．05）。Objective To explore the time selection of high volume continuous veno-venous hemofihration （HV-CVVH） in the treatment of severe acute pancreatitis （SAP）. Methods Twenty-four patients suffered from SAP were randomly divided into three groups： group Ⅰ with the treatment of HV-CVVH for 8h （ n =8）, group Ⅱ with the treatment for 16h （ n =8） and group Ⅲ with the treatment for 24h （ n = 8）. The patients in three groups underwent the treatment of HV-CVVH for 5 - 10 days. The plasma levels of tumor necrosis factor-α （TNF-α）, interleukin-1 （ IL-1 ）, IL-6, the APACHE Ⅱ scores and cure rate were measured before and after the treatment. Results After the treatment of HV-CVVH, the hemodynamic parameters of patients were apparently improved, and the APACHE Ⅱ scores were decreased. The levels of TNF-α, IL-1 and IL-6 were decreased after the treatment of HV-CVVH, and then reached the lowest point 8h later. The levels of TNF-α, IL-1 and IL-6 in the three groups were gradually increased to normal level. The APACHE Ⅱ scores and cure rate had no significant difference between the three groups （ P 〉 0. 05 ）. Conclusion HV-CVVH is effective in the treatment of severe acute pancreatitis. For SAP patients who are suit for the hemofiltration treatment, the treatment of HV-CVVH for 8h and for more than 8h has nearly the same effectiveness.

关 键 词：胰腺炎 血液滤过 

分 类 号：R657.51[医药卫生—外科学] R595.4[医药卫生—临床医学]