持续床旁血液滤过治疗重症急性胰腺炎并腹腔间隔室综合征  

Clinical Efficacy of Continuous Renal Replacement Therapy for Severe Acute Pancreatitis And Abdominal Compartment Syndrome

作　　者：韩飞[1] 戴建伟[1] 郭国湖[1] 邝泽建[1] 郑琼芝[1] 

机构地区：[1]汕头大学医学院第二附属医院ICU,广东汕头515000

出　　处：《医学临床研究》2015年第6期1099-1101,共3页Journal of Clinical Research

摘　　要：【目的】探讨持续床旁血液滤过（CRRT ）对重症急性胰腺炎（SAP）合并腹腔间隔室综合征（ACS）的治疗效果。【方法】收集本院重症监护室收治的 SAP 合并 ACS 的患者41例，根据是否行 CRRT 治疗分为两组，对照组18例拒绝行 CRRT 治疗，观察组23例给予 CRRT 治疗，观察并比较两组患者腹内压、APACHEⅡ评分、C 反应蛋白（CRP）、机械通气时间及1个月病死率。【结果】治疗1周、2周及4周时，观察组腹内压均较对照组同期及治疗前明显降低，且差异均有显著性（ P ＜0．05）；而对照组腹内压（除4周外）较治疗前未见明显改变（ P ＞0．05）；治疗1周后观察组 APACHE Ⅱ评分较治疗前明显降低，且差异有显著性（ P ＜0．05），治疗 2周、4周时对照组与观察组 APACHE Ⅱ评分均较治疗前明显降低，且差异有显著性（ P ＜0．05）；治疗1周、2周及4周时观察组患者血清 CRP 均较治疗前及对照组明显降低，且差异均有显著性（ P ＜0．05），对照组治疗 4周后 CRP 较治疗前明显降低（ P ＜0．05）。观察组平均机械通气时间为（602．7±51．8）h ，明显低于对照组（692．5±76．4） h ，且差异有显著性（ P ＜0．05）；观察组1 个月后患者病死率为73．91％（17／23），明显低于对照组83．33％（15／18），且差异有显著性（ P ＜0．05）。【结论】CRRT 能降低 SAP 合并 ACS 患者 A‐PACHE Ⅱ评分，减少脏器损害，缩短机械通气时间，降低患者的病死率。[Objective] To explore the clinical efficacy of continuous renal replacement therapy （CRRT ） for severe acute pancreatitis （SAP ） patients with concurrent abdominal compartment syndrome （ACS ） .[Methods] A total of 41 SAP patients with concurrent ACS were divided into two groups of observation and control based upon receiving CRRT or not .CRRT was declined by 18 cases in control group while 23 cases received CRRT in observation group .And inter‐group comparisons were made with respects to intra‐abdominal pressure ,Acute Physiology ＆amp; Chronic Health Evaluation Ⅱ （APACHE Ⅱ ） score ,C‐reactive protein （CRP） , duration of mechanical ventilation and mortality rate at Week 4 .[Results] After 1 ,2 and 4 weeks ,intra‐ab‐dominal pressures significantly decreased in observation group while there were no obvious changes in control group （ P 〈 0 .05） ;after 1 week ,the APACHE Ⅱ score was significantly lower than that pre‐treatment in ob‐servation group .And the inter‐group comparison had statistical difference （ P 〈 0 .05） ;after 2 and 4 weeks , APACHE Ⅱ scores were significantly lower than that pre‐treatment in both groups （ P 〈 0 .05） ;after 1 ,2 and 4 weeks ,serum CRP decreased versus pre‐treatment and control group （ P 〈 0 .05） .After 4 weeks ,CRP decreased significantly in control group （ P 〈 0 .05） .After 1 ,2 and 4 weeks ,CRP was lower significantly than control group （ P 〈 0 .05） ;average duration of mechanical ventilation declined in observation group ver ‐sus control group （602 .7 ± 51 .8 vs 692 .5 ± 76 .4h ,P 〈 0 .05） ;After 4 weeks ,the mortality rate was signifi‐cantly lower in observation group than that in control group （73 .91% vs 83 .33% ） .And the inter‐group differences were significant （ P 〈 0 .05） .[Conclusion] CRRT may reduce APACHE Ⅱ score ,lessen organ damage ,shorten mechanical ventilation duration and lower patient mortality .

关 键 词：胰腺炎  急性坏死性/并发症 腹膜疾病/并发症 血液滤过 

分 类 号：R576.1[医药卫生—消化系统]