早期连续性肾替代治疗对重症急性胰腺炎患者急性肺损伤的影响  

CRRT at early stageon in patients with severe acute pancreatitis applied to preventing acute lung injury in patients with severe acute pancreatitis

作　　者：谢敏丹 陈海丽[1] 林肖琴[1] 张近波[1] 

机构地区：[1]温州医学院附属温岭医院温岭市第一人民医院急救中心,浙江省温岭317500

出　　处：《中国基层医药》2015年第7期973-975,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温岭市科技局立项课题（2011wlcb0095）

摘　　要：目的：探讨早期连续性肾替代治疗（CRRT）对重症急性胰腺炎（SAP）患者急性肺损伤及预后的影响。方法将46例重症急性胰腺炎患者按照平行对照设计原理分为对照组和CRRT组。对两组IL-1β、IL-6、TNF-α水平、APACHEⅡ评分、氧合指数变化、急性肺损伤／急性呼吸窘迫综合征（ALI／ARDS）发生率及入住 ICU 时间进行比较。结果与CRRT组比较，对照组第1天IL-6水平均明显升高（t＝2．265，P＜0.05）；与CRRT组比较，对照组第3天IL-1β、IL-6、TNF-α水平均明显升高（t＝2．305、2．471、2．293，均P＜0.05）；与CRRT组比较，对照组第3天氧合指数均明显降低（t＝2．386，P＜0．05）。与对照组比较，CRRT组ALI／ARDS发生率、ICU住院时间、病死率明显降低（均P＜0．05）。两组性别、年龄、APACHE Ⅱ评分等差异均无统计学意义（均P＞0．05）。结论早期CRRT治疗SAP患者能通过清除重症胰腺炎患者IL-1β、IL-6、TNF-α等细胞因子，降低SAP患者ALI／ARDS发生率及升高氧合指数，使重症胰腺炎患者获得更大的临床效益。Objective To investigate the effects of early continuous renal replacement thempy（CRRT）on acute lung injury and prognosis in severe acute pancreatitis （SAP）patients.Methods 46 SAP patients were divided into the two groups randomly：the control group and CRRT treatment group.The levels of IL-1β,IL-6,TNF-α,the APACHEⅡscore,oxygenation index,the incidence of acute lung injury（ALI）/acute respiratory distress syndrome （ARDS）,ICU stay were compared between the two groups.Results The level of interleukin-6（IL-6）in the con-trol group was significantly higher than that in CRRT group in day 1（t=2.265,P0.05）.Conclusion Early CRRT therapy can eliminate the IL-1β,IL-6 and TNF-αin SAP patients,which can improve the oxygenation index and reduce the incidences of ALI/ARDS,may provide more clinical benefits in the early phase of SAP.

关 键 词：胰腺炎 白细胞介素 肿瘤坏死因子-α 连续性肾替代治疗 氧合指数 急性肺损伤/急性呼吸窘迫综合征 

分 类 号：R576[医药卫生—消化系统] R563.8[医药卫生—内科学]