早期连续性肾替代治疗对重症急性胰腺炎相关性肾损害的影响  

Effect of early CRRT on correlation kidney injury in patients with severe acute pancreatitis

作　　者：蒋帆[1] 黄文娣[1] 张凌志[1] 张近波[2] 

机构地区：[1]温岭市第一人民医院温州医科大学附属温岭医院康复科,浙江省温岭317500 [2]温岭市第一人民医院温州医科大学附属温岭医院EICU,浙江省温岭317500

出　　处：《中国基层医药》2015年第12期1794-1796,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）相关性肾损害的疗效及预后的影响。方法将40例 SAP 合并急性肾损害（AKI）患者按随机数字表法分为对照组21例和 CRRT 组19例，对照组行常规治疗，CRRT 组在常规治疗基础上行 CRRT 治疗。对两组患者的肌酐、尿素氮水平，TNF-α、IL-1、IL-6水平，APACHEⅡ评分及机械通气例数进行比较。结果与对照组比较，CRRT 组第3天肌酐、尿素氮水平均明显降低（t ＝2．836、2．952，P ＝0．003、0．004）；与对照组比较，CRRT 组患者第3天 IL-1、IL-6、TNF-α水平均明显降低（t ＝2．376、2．414、2．197，P ＝0．351、0．028、0．042）；与对照组患者比较，治疗后 CRRT 组患者APACHEⅡ评分、机械通气例数、病死率明显降低[（20．16±5．23）分与（13．83±4．48）分，14例（66．7％）与6例（31．6％），8例（38．1％）与2例（14．3％），t ＝4．572，χ^2＝4．912、4．043；P ＝0．0329、0．027、0．044]。结论早期 CRRT 治疗 SAP 患者能通过清除 SAP 患者 IL-1、IL-6、TNF-α等细胞因子，减轻患者急性肾损害，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 correlation kidney injury and prognosis in patients with severe acute pancreatitis（SAP）.Methods According to the digital table,40 SAP patients were randomly divided into two groups：the control group（21 cases）and CRRT treat-ment group（19 cases）.The levels of serum creatinine,urea nitrogen,IL -1,IL -6,TNF -α,the APACHEⅡscore, the incidence of mechanical ventilation were compared between the two groups.Results The levels of serum creati-nine,urea nitrogen were significantly lower in the CRRT group than those in the control group in day 3（t =2.836, 2.952,P =0.003,0.004）;The levers of IL -1,IL -6,TNF -αwere significantly lower in the CRRT group than those in the control group in day 3（t =2.376,2.414,2.197,P =0.351,0.028,0.042）;The APACHE II score,inci-dence of mechanical ventilation,the fatality rate in the CRRT group were significantly lower than those in the control group in day 3[（20.16 ±5.23）points vs.（13.83 ±4.48）points,14 cases（66.7%）vs.6 cases（31.6%）,8 cases （38.1%）vs.2 cases（14.3%）,t =4.572,χ^2 =4.912,4.043;P =0.0329,0.027,0.044].Conclusion Early CRRT therapy can eliminate the IL -1,IL -6 and TNF -αin SAP patients,can reduce the incidences of AKI,which may provide more clinical benefits in the early phase of SAP.

关 键 词：胰腺炎 急性坏死性 肾替代治疗 白细胞介素1 白细胞介素6 肿瘤坏死因子α 

分 类 号：R692.5[医药卫生—泌尿科学]