早期CVVH对重症胰腺炎合并急性呼吸窘迫综合征患者预后的影响  

Effect of early continuous venovenous hemofiltration on the prognosis of patients with severe acute pancreatitis complicated with acute respiratory distress syndrome

作　　者：张露[1] 王玮[1] 

机构地区：[1]湖北省襄阳市中心医院/湖北文理学院附属医院,湖北襄阳441021

出　　处：《现代中西医结合杂志》2016年第6期598-600,603,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨早期持续性静-静脉血液滤过(CVVH)对重症胰腺炎合并急性呼吸窘迫综合征患者预后的影响。方法将55例重症胰腺炎合并急性呼吸窘迫综合征患者随机分为观察组(n=29)和对照组(n=26),对照组给予常规治疗,观察组在对照组治疗的基础上给予早期CVVH治疗。统计2组治疗效果、通气时间及住ICU时间,观察治疗前后血流动力学、氧合指数、呼吸、体温、白细胞计数及血淀粉酶、血乳酸、降钙素原、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6水平。结果观察组有效率显著高于对照组(P<0.05);治疗3 d后,观察组呼吸、心率、白细胞计数及血淀粉酶、血乳酸、TNF-α、IL-1β、IL-6水平均显著低于对照组(P均<0.05),氧合指数显著高于对照组(P<0.05)。观察组通气时间及住ICU时间均显著短于对照组(P均<0.05)。结论早期CVVH能显著提高重症胰腺炎合并急性呼吸窘迫综合征患者的临床疗效,减轻炎症反应,缩短通气时间及住ICU时间,值得研究应用。Objective It is to investigate the influence of early continuous venovenous hemofiltration（ CVVH） on the prognosis of patients with severe acute pancreatitis complicated with acute respiratory distress syndrome. Methods 55 patients with severe acute pancreatitis complicated with acute respiratory distress syndrome were randomly divided into observation group（ n = 29） and control group（ n = 26）. The patients were treated with conventional method in the control group,while with early CVVH treatment combine with the conventional treatment in the observation group. The curative effect,ventilation time and ICU time were recorded in two groups. Before and after treatment,the blood flow dynamics,oxygenation index,respiratory rate,body temperature,white blood cell count,as well as the level of amylase,blood lactic acid,calcitonin,TNF-α,IL- 1β,IL- 6 were observed and compared. Results The effective rate in the observation group was significantly higher than that in the control group（ P〈0. 05）; after three days of treatment,the respiratory rate,heart rate,white blood cell count,and the levels of serum amylase,lactic acid,TNF- α,IL- 1β and IL- 6 in the observation group were significantly lower than those in the control group（ all P〈0. 05）,and the oxygenation index was significantly higher than that in the control group（ P〈0. 05）. The ventilation time and ICU time in observation group were significantly shorter than those in the control group（ all P〈0. 05）. Conclusion Early CVVH treatment can significantly improve the clinical effect of patients with severe acute pancreatitis complicated with acute respiratory distress syndrome,reduce the inflammatory reaction,shorten the time of ventilation and in ICU,it is worth of clinical attention.

关 键 词：重症胰腺炎 急性呼吸窘迫综合征 持续性静-静脉血液滤过 炎性因子 

分 类 号：R657.51[医药卫生—外科学]