早期高容量血液滤过持续时间对重症急性胰腺炎急性肺损伤影响的研究  

Effect of Lower Duration in Early HighVolume Hemofiltration on Severe Acute Pancreatitis with Acute Lung Injury

作　　者：尹辉明[1] 蒋玉兰[1] 唐春霞[1] 杨晶[1] 

机构地区：[1]怀化医专附属医院暨怀化市第三人民医院ICU,湖南怀化418000

出　　处：《怀化医学高等专科学校学报》2010年第1期46-49,共4页

摘　　要：目的研究早期高容量血液滤过（HVHF）持续时间对重症急性胰腺炎（SAP）急性肺损伤（ALI）的影响。方法自2006年8月至2009年4月，前瞻性随机将ICU收治的49例SAP，八院时合并ALI／ARDS（急性呼吸窘迫综合征），并在72h内接受HVHF治疗的患者分为两组，在常规治疗的基础上分别接受不同血滤持续时间8h（Ⅰ组）和72h（Ⅱ组）治疗，比较两组病人的APACHEII评分、氧合指数、ALL/ARDS的发生率、机械通气的例数及时间、急性期并发症、HVHF相关并发症、结局及医疗费用等。结果（1）氧合指数及APACHEII评分：两纽入院第3、14d天均较入院当天明显改善（P〈0．05），但两组病人比较差异无统计学意义（P〉0．05）。（2）ALI、ARDS的发生率：两组入院第14d较入院当天明显降低（P〈0．05）；但在入院第3、14d，两组病人比较差异无统计学意义（P〉0．05）。（3）机械通气：两组病人急性期机械通气的例数及时间差异无统计学意义（P〉0．05）。（4）急性期并发症（MODS、ARF、IAH、导管相关感染、低血压）及医疗费用：两组病人急性期并发症、结局差异无统计学意义（P〉0．05），但Ⅰ组费用较Ⅱ组低，差异有统计学意义（P〈0．05），且Ⅰ组无低血压发生。结论发病72h内的SAP早期短时（8h）持续性HVHF治疗能有效促进合并ALI／ARDS的SAP病人肺功能的恢复，并且明显节约医疗费用及减少低血压等治疗风险。Objective To investigate the effect of continuous time in early high volume hemofihration （HVHF） on lung function in patients with severe acute pancreatitis. Methods 49 patients with SAP, accompanying acute lung injury （ALI） and being admitted between Augest 2008 and April 2009 to ICU were divided at prospective random into two groups, the first group （HVHF continuous 8 hours） and the second group （HVHF continuous 72 hours） .The oxygenation index, the morbidity of ALI/ARDS and the case and time of mechanical ventilation （MV） etc. of the two groups were compared. Results （ 1 ） The oxygenation indexes and APACHEII in the two groups, the oxygenation indexes and APAACHEII on the 3rd and 14th day after admission were improved greater than those on the admission （P 〈 0.05）, but there were no significant difference between the two groups on the 3rd, 14th day （P〉0.05） （2） The incidence rate of ALI/ARDS on the 14th day after admission was lower than that on the admission （P 〈 0.05）, but there were no significant difference between the two groups on the 3rd, 14th difference between the two groups of the patients treated with complications in acute stage and hospitalization cost： There MODS ARF, hypotension, IAH vessel infection and mortality day （P〉 MV and 0.05 ） （3 ） The MV ： There were no significant the duration time of MV （ P 〉 0.05 ） （4） The were no significant （P〈0.05） but the difference between the two groups in hospitalization cost has significant difference between the two groups （P 〈 0.05 ） Conclusion Early continuous 8 hours high volume hemofihration can improve the function of lung in SAP as same as 72 hours, and the former can reduce cost and risk.

关 键 词：重症急性胰腺炎 急性肺损伤 早期高容量血液滤过 持续时间 

分 类 号：R576[医药卫生—消化系统]