重症急性胰腺炎连续性血液净化的时机和模式选择  

Opportunity and mode slection of continuous blood purification for severe acute pancreatitis

作　　者：王兆[1] 杨蕾[1] 陈微微[1] 

机构地区：[1]遵义医学院第三附属医院ICU,贵州遵义563002

出　　处：《现代医药卫生》2013年第6期820-821,823,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨重症监护病房(ICU)中连续性血液净化(continous blood purification,CBP)治疗重症急性胰腺炎(SAP)的时机和模式选择及疗效。方法对32例SAP患者在常规治疗基础上早期(发病72 h内)行CBP,模式选择血液透析滤过(HDF)或高容量血液滤过(HVHF),并对其治疗时机及效果进行总结分析。结果 SAP患者在发病后72 h内行CBP可明显改善心率、呼吸频率、平均动脉压、氧合指数、血乳酸、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及主要生化指标水平,明显降低降钙素原(PCT)及白介素(IL)-6水平,27例患者在行CBP后病情有所缓解,有效率为84.4%,5例患者因出现进行性多器官功能衰竭死亡,病死率为15.6%。结论 SAP一旦确诊,根据并发症不同早期选择适当模式,并发急性肾损伤时选择HDF,并发急性呼吸窘迫综合征(ARDS)或多器官功能障碍综合征(MODS)时选择HVHF,可提高患者生存率,改善预后。Objective To discuss the opportunity,mode and curative effect of continuous blood purification（CBD）for treating severe acute pancreatitis（SAP）.Methods 32 cases of SAP were performed CBP with the mode of hemodiafiltration（HDF） or high volume hemofiltration（HVHF） at the early time（within 72 h after onset） based on the routine therapy.The treatment oportunity and effects were analyzed and summarized.Results Adopting CBP in the patients with SAP within 72 h after onset could effectively improve the heart rate,respiratory frequency,average angiosthenia,oxygenation index,blood lactate,APACHEⅡ scores and the main biochemical indexes,and obviously reduce the the inflammation indexes procalcitonin（PCT） and IL-6.27 cases of ASP were effectively relieved with the effective rate of 84.4%,5 cases died due to progressive multiple organ failure,with the mortality rate of 15.6%.Conclusion Once diagnosing SAP,the patients should be cured by selecting the proper mode in early time.Selecting HDF for the patients complicating acute kidney injury and HVHF for the patients complicating acute resperatory distress syndrome（ARDS） or multiple organ dysfunction syndrome（MODS） can increase the survival rate and improve theprognosis.

关 键 词：急性病 胰腺炎 血液滤过 肾透析 

分 类 号：R657.51[医药卫生—外科学]