高容量血液滤过治疗重症急性胰腺炎的效果  

Therapeutic effect of continuous high - volume hemofiltration in severe acute pancreatitis

作　　者：宋雪霞[1] 王英[1] 

机构地区：[1]广西医科大学第四附属医院肾内科,广西柳州545005

出　　处：《中国急救医学》2011年第6期534-536,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的观察连续性血液净化（CBP）的高容量血液滤过（HVHF）和常规剂量的连续性静脉-静脉血液滤过（CVVH）治疗重症急性胰腺炎（SAP）患者的效果。方法43例SAP患者随机分为HVHF组和CVVH组，分别检测两组患者治疗前、治疗后每24h血清C反应蛋白（CRP）水平，比较两组预后、治疗前后APACHEⅡ评分变化及血清CRP水平在各个时间点有无显著性差异。结果HVHF组22例患者死亡3例，死亡率13．64％；CVVH组21例患者死亡8例，死亡率38．10％。两组治疗后APACHEⅡ评分均较治疗前差异有统计学意义（P〈0．05），但以HVHF组更为显著（P〈0．05）。两组均能降低血清CRP水平，但以HVHF组下降更为明显（P〈0．01），HVHF组各时间点CIIP水平均较CVVH组显著降低，两组比较差异有统计学意义（P〈0．05）；在HVHF治疗期间，血清CRP水平逐渐降低，以治疗后72h下降更为明显，与治疗前、治疗后24h、48h比较，差异均有统计学意义（P〈0．01）。结论在SAP患者连续性血液净化治疗方式选择上，更适宜选用HVHF治疗；连续的CRP检测有助于判断SAP患者HVHF治疗的预后。Objective To investigate the therapeutic effects of continuous high - volume hemofiltration（ HVHF ） and continuous veno -venous hemofihration （CVVH） in severe acute pancreatitis （SAP）. Methods Forty - three patients were randomly divided into 2 groups ： HVHF group and CVVH group. The C - reactive protein （CRP） levels before treatment and every 24 hours after treatment were measured respectively in the 2 groups, the prognosis, the pre - and post - treatment APACHE I score and the CRP level at different time points were compared. Results Three patients died in HVHF group which contained twenty -two patients, the mortality rate was 13.64 percent; eight patients died in CVVH group which contained twenty -one patients, the mortality rate was 38. 10 percent. There was significantly different in APACHE II score between pre - and post - treatment （ P 〈 0. 05 ）, especially in HVHF group（ P 〈 0.05 ）. Serum CRP were decreased more significantly at different time points in HVHF than in CVVH group （ P 〈 0. 05 ）, and CRP were decreased more significantly at 72 b than pretreatment and at 24 h,48 h in HVHF group （P 〈 0. 01 ）. Condusion HVHF is more beneficial for SAP patients than other continuous blood purification （CBP） methods. Continuous CRP detection can help to judge the prognosis with HVHF in SAP.

关 键 词：高容量血液滤过(HVHF) 连续性静脉-静脉血液滤过(CVVH) 重症急性胰腺炎(SAP) C反应蛋白(CRP) 全身炎症反应综合征(SIRS) 

分 类 号：R692.5[医药卫生—泌尿科学]