CRRT 联合腹腔引流对重症胰腺炎合并 IAH／ACS的影响研究  

Effect of CRRT combined with abdominal drainage on severe acute pancreatitis complicated with IAH/ACS

作　　者：邹鑫森[1] 张可祥[1] 崔勇[1] 潘鹏飞[1] 周岐龙 刘超[1] 

机构地区：[1]重庆三峡中心医院ICU, 重庆 万州404000

出　　处：《中国急救医学》2015年第10期883-887,共5页Chinese Journal of Critical Care Medicine

基　　金：重庆市万州区科委课题（201403014）

摘　　要：目的：评价连续肾脏替代疗法（continuous renal replacement therapy ， CRRT）联合腹腔穿刺引流在防治重症急性胰腺炎（ severe acute pancreatitis ， SAP ）并发腹腔高压（ intra－abdom inal hypertension ， IAH）／腹腔间隔室综合征（ abdominal compartment syndrome ， ACS）的效果。方法将2014－01～2015－04我科收治的84例SAP患者在完成基础治疗后随机分为四组，每组21例，A组给予腹水引流；B组给予间断CRRT；C组给予间断CRRT＋引流；D组不给予间断CRRT及引流。观察各组患者APACHEⅡ评分，Balthazar CT积分，腹压，血及腹水淀粉酶、IL－6、IL－8，腹腔感染，手术情况，28 d腹腔局部并发症。结果 C组第3、7、14天的APACHEⅡ评分与A、B、D组比较差异有统计学意义（P＜0．05），且各组与治疗前比较差异有统计学意义（P＜0．05）；C组第7、14天的腹压与A、B、D组比较差异有统计学意义（P＜0．05），各组病例第7天腹压达高峰，与治疗前及第3、14天腹压比较差异有统计学意义（P＜0．05）；C组第7、14天Balthazar CT积分与A、B、D组比较差异有统计学意义（P＜0．05），C组第7天Balthazar CT 积分与治疗前比较差异有统计学意义（P＜0．05），各组第14天Balthazar CT积分与治疗前比较差异有统计学意义（P＜0．05）；C组第7、14天血、腹水中淀粉酶、IL－6、IL－8与A、B、D组比较差异有统计学意义（P＜0．05），各组与治疗前比较差异有统计学意义（P＜0．05）；同时间点腹水IL－6、IL－8高于血中各指标值（P＜0．05）；C组腹腔感染及28 d胰腺局部并发症与A、D组比较差异有统计学意义（P＜0．05）。结论 CRRT联合腹腔引流可能更有效地减轻SAP时腹腔压力、腹腔内炎症反应、腹腔感染及胰腺局部并发症。Objective To evaluation the effect of continuous renal replacement therapy （ CRRT） combined with abdominal drainage on severe acute pancreatitis （ SAP ） complicated with intra-abdominal hypertension/abdominal compartment syndrome （ IAH/ACS ） .Methods Eighty -four SAP patients admitted our department and finished basal treatment from January 2014 to April 2015 were randomly divided into four groups , with 21 cases in each group .Group A： treated with the abdominal drainage; group B： treated with intermittent CRRT; group C： treated with intermittent CRRT＋drainage;group D：not treat with CRRT or drainage .Clinical data were collected among all the groups, including APACHEⅡ score, Balthazar CT integral, abdominal pressure, blood and ascites amylase, IL-6, IL -8, abdominal infection , operation conditions , 28 days of intraperitoneal local complications.Results The APACHEⅡ scores in group C on 3 d, 7 d, 14 d were significant lower＆amp;nbsp;than those in group A, B and D, respectively （P〈0.05）, and the APACHEⅡ scores in all groups were significant lower than those before treatment （P〈0.05）.Abdominal pressure in group C on 7 d, 14 d was significant lower than that in group A , B and D, respectively （P〈0.05）;abdominal pressure in every group reached the peak at time of 7 d, and was significant higher than those before treatment , 3 d, 14 d of treatment （P〈0.05）.Balthazar CT integral in group C at time of 7 d, 14 d was significant lower than that in group A, B and D, respectively （P〈0.05）;Balthazar CT integral in group C at time of 7 d was significant difference than that before treatment （P〈0.05）; Balthazar CT integral in each group at time of 14 d was significant lower than that before treatment （P〈0.05）.The blood, ascites amylase, IL-6, IL-8 in group C at time of 7 d, 14 d were significant lower than those in group A , B and D, respectively （P〈0.05）;these indexes in each group were significantly lower than those before treatment （P〈0.05）

关 键 词：连续肾脏替代疗法(CRRT) 腹腔引流 重症急性胰腺炎(SAP) 腹腔高压/腹腔间室综合征(IAH/ACS) 预后 

分 类 号：R657.51[医药卫生—外科学]