连续性血液滤过治疗重症急性胰腺炎临床评价  

Effects of continuous blood purification on patients with severe acute pancreatitis

作　　者：杨丽敏[1] 陈兵[1] 刘毅[1] 丁红叶[1] 李立宇[1] 

机构地区：[1]天津医科大学第二医院ICU,天津300211

出　　处：《中华急诊医学杂志》2012年第6期633-637,共5页Chinese Journal of Emergency Medicine

基　　金：天津医科大学科学基金（2009KY23）

摘　　要：目的探讨连续性静脉一静脉血液滤过（CVVH）治疗重症急性胰腺炎（SAP）的临床疗效。方法对2005年6月至2010年6月天津医科大学第二医院ICU收治的45例SAP患者进行回顾性分析，随机（随机数字法）分为常规治疗组、综合治疗组。常规治疗组22例，采用快速而充分的液体复苏、血管活性药物改善脏器灌注、抑制胰酶分泌、足量广谱抗生素预防感染、早期肠道营养保护肠黏膜屏障等治疗；综合治疗组23例，在常规治疗基础上加CVVH治疗。分别观察两组患者人院时及治疗72h后急性生理和慢性健康状况（APACHEⅡ）评分、多脏器功能障碍综合征（MODS）评分、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-8（IL-8）变化。比较两组患者呼吸机治疗时间、ICU住院时间及存活率差异。计量资料组内比较采用配对t检验，各组相关资料构成比及存活率比较采用X2检验，以P〈0．05为差异有统计学意义。结果两组患者入院时APACHEⅡ评分、MODS评分及BUN、Scr、TBIL、ALT、AMS、TNF—α、IL-6、IL8及CRP比较差异均无统计学意义（P〉0．05）。与常规治疗组相比，治疗72h后综合治疗组的临床症状改善明显，APACHEⅡ评分、MODS评分差异有统计学意义（P〈0．05）；BUN、Scr、TBIL、ALT、AMS、TNF—α、IL石、IL-8及CRP均下降明显，差异具有统计学意义（P〈0．05）。综合治疗组和常规治疗组呼吸机治疗时间[（7．6±3．4）dVS．（11．5±4．7）d]、ICU住院时间[（12．3±7．8）dVS．（17．6±9．2）d]及抢救存活率（86．96％VS．59．09％）比较差异有统计学意义（P〈0．05）。结论在常规综合治疗的基础上加用CVVH治疗SAP，能有效清除患者致炎介质和毒素，维持内环境稳定，改善氧合功能，补充营养，提高抢救成功率。Objective To explore the therapeutic effect of continuous veno-venous hemofiltration （CVVH） on the treatment of severe acute pancreatitis （SAP）. Methods All data about forty-five patients with SAP admitted to the intensive care unit （ICU） from June 2005 through June 2010 were reviewed. These 45 patients were randomly （random number ） divided into routine treatment group （n = 22 ） and comprehensive treatment group （ n = 23 ）. In control group, patients were rapidly given with a sufficient liquid support, vasoactive drug to increase organ perfusion, trypsin secretion inhibitor, broad-spectrum antibiotics, enteral nutrition with intestine membrane protective agent in early stage. In the comprehensive treatment group, patients received CVVH integrated with routine treatment. On admission and 72 h post- treatment, the scores of acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） and multiple organ dysfunction syndrome （ MODS）, and the results of standard bettery of biochemistry tests indcluding blood urea nitrogen （ BUN）, serum cratinine （Scr） , total bilirubin （ TBIL）, alanine aminotransferase （ ALT）, amylase （AMS）, C-reactive protein （CRP）, TNF-a, IL-6, IL-8 were observed. Time of mechanical ventilation support, length of ICU stay, and survival rate were compared between two groups. Results On admission between the two groups, no statistical significance was seen in the APACHEⅡ and MODS score, BUN, Scr, TBIL, ALT, AMS, CRP, TNF-α, IL-6, IL-8 （P 〉0. 05）. But APACHE II and MODS score were decreased significantly in comprehensive treatment group than in the routine treatment group, as well as the the level of BUN, Scr, TBIL, ALT, AMS, TNF-α, IL-6, IL-8 and CRP after 72h post-treatment （P 〈 0. 05）. In routine treatment group and comprehensive treatment group, the time of respirator intervention andlength ofstayin ICU were （7.6±3.4） dvs. （11.5±4.7） d, （12.3±7.8） dvs. （17.6±9.2） d respectively, the statistical signifi

关 键 词：连续性血液滤过 连续性血液净化治疗 重症急性胰腺炎 全身炎症反应综合征 多脏器功能障碍综合征 腹腔间隔室综合征 治疗 评价 

分 类 号：R576[医药卫生—消化系统]