CVVH加腹腔引流治疗重症急性胰腺炎临床观察  

Clinical efficacy of continuous veno-venous hemofiltrati and the belly drainage by abdominal puncture and laying drainage tube in treatment of severe acute pancreatitis

作　　者：卢阳[1] 何沈静[1] 吴建祥[1] 王庆宇[1] 朱宇[1] 蔡继明[1] 何群[1] 何涛[1] 黄俊军[1] 

机构地区：[1]嘉兴学院医学院附属第二医院ICU,浙江嘉兴314000

出　　处：《临床医学》2008年第7期13-16,共4页Clinical Medicine

摘　　要：目的观察连续静脉-静脉血液滤过(CVVH)加腹腔引流治疗重症急性胰腺炎(SAP)的临床疗效。方法31例SAP患者在接受基础治疗的同时行CVV H加腹腔引流治疗,每例次至少持续32 h;监测并计算血气分析、血生化、CRP、炎症细胞因子、血乳酸、血流动力学、氧合功能及胃粘膜内pH值、膀胱压及APACHEⅡ评分的变化。结果所有患者经治疗1天后血气分析、血生化、血乳酸、血流动力学指标、氧合功能参数、膀胱压(UBP)、炎症细胞因子及APACHEⅡ评分有显著改善P<0.01)。血pH值、胃粘膜内pH值(PHi)治疗1 d后明显升高(P<0.05),治疗3 d后,差异有统计学意义P<0.01)。结论早期、及时、合理地使用CVVH加腹腔引流,能有效减少临床并发症,降低病死率,可成为治疗SAP的重要措施。Objective Clinical efficacy of continuous veno-venous hemofiltrati and the belly drainage by abdominal puncture and laying drainage tube in treatment of severe acute pancreatitis.Methods Thirty-one patients with SAP were involved,CVVH was performed for at least 32 hours.During CVV H,the patient′s arterial blood gas analysis,blood biochemical index,C-reactive protein（CRP）,plasma cytokines,blood lactate,hemodynamics,the ability of oxygenator,gastric intramucosal PH（PHi）,urinary bladder pressure（UBP）,acute physiology and chronic health evaluation II（APACHE II） score were detected.Results After CVVH and the belly drainage by abdominal puncture and laying drainage tube for 1day,it was significantly effective of arterial blood gas analysis,blood biochemical index,blood lactate,hemodynamics,the ability of oxygenator,urinary bladder pressure（UBP）,plasma cytokines,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score（P〈0.01）.After 1 day,pH in the whole blood and gastric intramucosal pH（pHi） were significantly impoved（P〈0.05）,After 3 days,There were highly significant（P〈0.01）.Conclusion CVVH and the belly drainage by abdominal puncture and laying drainage tube could effectively treat the complication and reduce the mortality rate of SAP with multiple organ dysfunction syndrome.Early and timely and rational used CVVH and the belly drainage by abdominal puncture and laying drainage tube may become one of the importance therapies to improve outcome.

关 键 词：重症急性胰腺炎 CVVH 腹腔引流 

分 类 号：R576[医药卫生—消化系统]