早期短时静脉-静脉血液透析滤过对重症急性胰腺炎病人合并急性肾损伤的治疗  

Effect of early short veno-venous hemodiafiltration on severe acute pancreatitis patients with acute kidney injury

作　　者：李艳秀[1] 王勇[1] 左祥荣[1] 曹权[1] 

机构地区：[1]南京医科大学第一附属医院ICU,江苏南京210029

出　　处：《外科理论与实践》2012年第6期673-677,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:研究早期短时静脉-静脉血液透析滤过(short veno-venous hemodiafiltration,SVVHDF)对重症急性胰腺炎(severe acute pancreatitis,SAP)病人合并急性肾损伤(acute kidney injury,AKI)的治疗效果。方法:SAP合并AKI的25例病人包括SVVHDF组(15例)和对照组(10例)。监测两组病人治疗前、后血清肌酐(Cr)、血尿素氮(BUN)、血pH值和APACHEⅡ评分的变化,以及SVVHDF组病人在SVVHDF治疗过程中呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、电解质(K+、Na+及Cl-)、临床症状和体征的变化。结果:SVVHDF治疗12 h后,SVVHDF组病人的BUN、Cr和APACHEⅡ评分明显降低(P<0.05),血pH值明显升高(P<0.05),而对照组病人在常规治疗12 h后的变化无统计学差异(P>0.05);SVVHDF组病人腹痛消失、腹胀缓解时间均较对照组明显缩短(P<0.05)。SVVHDF组病人在SVVHDF治疗4 h后RR、HR和CVP显著下降(P<0.05)。治疗6 h后MAP显著上升(P<0.05);治疗过程中电解质变化无统计学差异(P>0.05)。结论:早期应用SVVHDF能迅速缓解SAP合并AKI病人的症状和体征,显著改善病情并逆转肾功能不全。Objective To investigate the effect of early short veno-venous hemodiafiltration （SVVHDF） in the treatment of severe acute pancreatitis（SAP） patients with acute kidney injury（AKI）. Methods Twenty-five SAP patients with AKI were studied including the SVVHDF group （n=lS） and the control group （n=10）. Serum creatinine （Cr）, blood urea nitrogen （BUN）, arterial pH value, and APACHE II scores of the two groups were evaluated. The respiratory rate （RR）, heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, electrolytes induding potassium, sodium, chlorine, clinical symptoms and signs were recorded at scheduled intervals in the SVVHDF group. Results Baseline characters of the patients were comparable for the two groups. BUN, Cr and APACHE II scores in patients decreased significantly and pH value improved significantly with SVVHDF at 12 hours after treatment （P〈O.05）. No obvious change was observed in patients of the control group （P〉0.05）. The abdominal pain and distension were remitted earlier in the SVVHDF group than in the control group （P〈0.05）. In the SVVHDF group, RR, HR and CVP decreased significantly at 4 hours and MAP increased significantly at 6 hours after treatment （P〈O.05）. Electrolytes did not change during SVVHDF treatment （P〉O.05）. Conclusions The early application of SVVHDF can alleviate the clinical symptoms and signs of SAP patients with AKI, improve the condition and recover the renal insufficiency significantly.

关 键 词：短时静脉-静脉血液透析滤过 重症急性胰腺炎 急性肾损伤 

分 类 号：R576[医药卫生—消化系统]