早期反复间断血滤治疗重症急性胰腺炎的临床研究  

Early repeated intermittent veno-venous hemofiitration in the treatment of severe acute pancreatitis

作　　者：姚欣敏[1] 刘牧[1] 李云涛[1] 黄德全[1] 曹扬[1] 程金川[1] 文君[1] 黄江涛[1] 于澜[1] 彭秋生[1] 龚容[1] 

机构地区：[1]成都市第三人民医院普通外科,成都610031

出　　处：《中华胰腺病杂志》2009年第3期156-159,共4页Chinese Journal of Pancreatology

基　　金：成都市卫生局科技研究基金课题（2004-46）

摘　　要：目的评价早期反复间断静脉-静脉血滤（repeated intermittent veno—venous hemofiltration，RIVVH）治疗重症急性胰腺炎（SAP）的临床价值。方法70例SAP患者按随机数字表法分为RIVVH组（40例）和对照组（30例）。两组病情具有可比性。治疗除血滤外，基本相同。比较两组患者的生命体征、临床表现、血糖、氧合指数、肝肾功能、淀粉酶、脂肪酶、TNF—α浓度、C-反应蛋白、细菌培养阳性率、治疗前后Bahhazar CT评分和APACHEⅡ评分、手术率、并发症发生率、病死率、平均住院时间以及费用。结果发病后平均47．6h开始行RIVVH。RIVVH组治疗后1d生命体征、血糖、氧合指数、肝肾功能、淀粉酶、脂肪酶、TNF-α浓度、C-反应蛋白水平均较治疗前明显改善，且明显优于对照组（P〈0．05）。RIVVH组治疗前及治疗后1、2、3、5、10d APACHEⅡ评分分别为15．5±5．2、9．7±2．6、8．0±1．9、7．2±1．5、5．5±1．0、4．0±0．8，均明显低于同时段对照组的评分（P〈0．01）。治疗后14d RIVVH组Bahher CT评分为5．1±1．1，显著低于对照组的6．8±1．3（P〈0．001），也较术前的8．0±1．8明显降低（P〈0．001）。RIVVH组淀粉酶及脂肪酶恢复正常时间、腹痛腹胀缓解时间、细菌培养阳性率、手术率、病死率、平均住院时间和平均治疗费用分别为（1．3±1．0）d、（2．0±1．0）d、（38．2±29．0）d、27．5％、10％、5％、（28．2±16．3）d和（42842．18±27372．49）元，均较对照组显著缩短或降低（P〈0．05或P〈0．01）；RIVVH组并发症发生例数也较对照组少（P〈0．05）。结论早期RIVVH治疗SAP疗效满意，有望成为SAP重要的辅助治疗措施。Objective To evaluate the efficacy of early repeated intermit tent veno-venous hemofiltration （RIVVH） in the treatment of severe acute pancreatitis （SAP）. Methods 70 patients were randomly divided into RIVVH group （40 cases） and control group （30 cases）. The two groups＇ conditions were comparable. The management of these two groups was similar except for RIVVH. The vital signs, clinical presentations, serum glucose, oxygenation index, liver and kidney function, amylase, lipase, TNF-α concentration, CRP, positive rate of bacterial culture, Balthazar CT score and APACHE Ⅱ score before and after treatment, surgery rate, complication rate, mortality rate, average hospital stay and costs were compared between the two groups. Results RIVVH was started average 47.6 h after the onset of the disease. 1 day later, the values of vital signs, serum glucose, oxygenation index, liver and kidney function, amylase, lipase, TNF-α concentration, CRP in treatment group were significantly better than those in the control group （P 〈 0.05）. The APACHE 11 scores before treatment and 1, 2, 3, 5,10 d later were 15.5 ± 5.2, 9.7 ± 2.6, 8.0 ± 1.9, 7.2 ±1.5, 5.5 ± 1.0, 4.0 ± 0.8,which were significantly better than those corresponding values in the control group （P〈0.05）. 14 d after treatment, the Bahhazar CT score was 5. 1 ± 1. 1 in treatment group, which was significantly lower than that 6.8 ± 1.3 in the control group （P 〈0. 001 ） and lower than that 8.0 ± 1.8 before RIVVH （ P 〈 0. 001 ）. The normalization time of amylase, fipase, alleviating time of abdominal pain and bloating, positive rate of bacterial culture, surgery rate, mortality rate, average hospital stay, mean medical costs were （1.3 ±1.0）d, （2.0 ± 1.0）d, （38.2 ±29.0）d, 27. 5% ,10% ,5% , （28. 2 ± 16.3）d and （42842.18 ±27372.49） RMB, which were significantly lower than those in the control group （P 〈0.05 or P 〈 0.01 ）. The complication rate in RIVVH was lower than that in the control group （

关 键 词：胰腺炎 急性坏死性 静脉血液滤过 TNF—α 随机对照试验 

分 类 号：R576[医药卫生—消化系统]