持续血液滤过治疗高脂血症性急性胰腺炎24例  

Treatment of hyperlipidemic acute pancreatitis by continuous venovenous hemof iltration:an analysis of 24 cases

作　　者：黄鹏[1] 王春友[2] 吴河水[2] 吴国俊[3] 黎建军[3] 

机构地区：[1]广西中医学院附属瑞康医院肝胆外科,广西壮族自治区南宁市530011 [2]华中科技大学同济医学院附属协和医院胰腺外科,湖北省武汉市430022 [3]武汉科技大学附属普仁医院肝胆外科,湖北省武汉市430081

出　　处：《世界华人消化杂志》2012年第11期964-968,共5页World Chinese Journal of Digestology

摘　　要：目的：观察早期连续血液滤过（continuous veno-venous hemofiltration,CVVH）对高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis,HLP）的治疗效果.方法：49例HLP患者随机分为2组：连续血液滤过组（A组,n=24）和对照组（B组,n=25）.在常规治疗的基础上,A组加用连续血液滤过.观察治疗前后两组患者的心率（HR）、呼吸（R）、氧合指数（PO2/FiO2）、血氧饱和度（SaO2）、血清甘油三酯（TG）、白介素-6（IL-6）以及肿瘤坏死因子-α（TNF-α）等指标的变化;并行APACHE~ 动态评分;比较两组治疗前后急性并发症的变化及治愈率.结果：经CVVH治疗后72h,患者临床症状改善明显,HR、R降至正常,APACHE~评分下降明显（10.8±5.1vs15.5±6.9,P〈0.05）;血清TG、IL-6及TNF-α亦明显下降（6.8±3.7vs18.5±6.3,39.8±16.7vs72.4±25.1,37.5±14.1vs61.2±16.1,P〈0.05）.治疗7d后,两组休克均获纠正（P〈0.05）.A组ARDS和急性肾功能障碍控制迅速,发生率下降明显（5.0%vs37.5%,5.0%vs25%,P〈0.05）.A组治愈22例,死亡2例,死亡率8.3%;B组治愈20例,死亡5例,死亡率20%,治疗效果显著.结论：CVVH治疗HLP有明显的效果,能有效改善患者病情,降低病死率.AIM：To observe the treatment effect of continuous veno-venous hemofiltration（CVVH） in patients with hyperlipidemic acute pancreatitis（HLP）.METHODS：Forty-nine HLP patients were randomly divided into two groups：CVVH group（A,n = 24） and control group（B,n = 25）.Both groups underwent conventional therapy,and patients in group A additionally underwent CVVH.Heart rate（HR）,respiration,PO2/FiO2,SaO2,triglyceride（TG）,IL-6 and TNF-α were monitored.APACHE score was used to evaluate patients＇ condition.The incidences of acute complications and survival rate were compared between the two groups.RESULTS：After treatment by CVVH,HR,respiration,APACHE（10.8 ± 5.1 vs 15.5 ± 6.9,P 0.05） as well as serum levels of TG,IL-6 and TNF-α（6.8 ± 3.7 vs 18.5 ± 6.3,39.8 ± 16.7 vs 72.4 ± 25.1,37.5 ± 14.1 vs 61.2 ± 16.1,all P 0.05） decreased signif icantly.Seven days later,shock was corrected in both groups（P 0.05）.In group A,the incidences of acute renal failure（ARF） and acute respiratory distress syndrome（ARDS） were significantly decreased（5.0% vs 37.5%,5.0% vs 25%,both P 0.05）.Compared to group B,group A had a higher survival rate（8.3% vs 20%）.CONCLUSION：CVVH is effective in treating HLP and is associated with a lower case fatality rate.

关 键 词：连续性静脉-静脉血液滤过 高脂血症 急性胰腺炎 

分 类 号：R657.51[医药卫生—外科学]