早期血液滤过治疗重症急性胰腺炎的效果及预后  

Efficacy of early hemofiltration for severe acute pancreatitis

作　　者：姜立[1] 何小宇 张敏[1] 秦仁义[1] 王欣[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030 [2]深圳市人民医院普外科

出　　处：《腹部外科》2016年第6期416-419,共4页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81472705;81272425;81372353)

摘　　要：目的探讨重症急性胰腺炎采用早期血液滤过治疗的临床价值。方法通过前瞻性的随机对照方法的原则,纳入同济医院2011年9月至2015年11月收治的确诊为重症急性胰腺炎病人共100例,所有病例均在发病72 h内接受治疗,采取随机分组方法,对照组采用的是常规对症内科治疗、胃肠减压、灌肠肠内营养、腹腔穿刺引流等方法;早期血液滤过治疗组则在对照组的基础上进行早期血液滤过治疗。分别观察两组病人1周内的急性生理学与慢性健康状况系统Ⅱ(APACHE-Ⅱ)和Balthazar CT评分,同时记录并发症发生率和病死率。结果入院治疗后从第3天开始,早期血液滤过治疗组的APACHE-Ⅱ评分低于对照组,两组差异具有统计学意义;入院后第7天行CT检查Balthazar评分早期血液滤过治疗组低于对照组,两组差异具有统计学意义;早期血液滤过治疗组7 d后并发症和死亡的发生率低于对照组,差异具有统计学意义。结论早期血液滤过治疗可以降低重症急性胰腺炎的并发症及病死率,是治疗重症急性胰腺炎有效方法之一。Objective To investigate the clinical value of early hemofiltration for severe acute pancreatitis （SAP）. Methods Using prospective randomized controlled method, 100 cases of SAP admitted into Tongji Hospital from Sep. 2011 to Nov. 2015 were enrolled in this study, and all patients were treated within 72 h after onset. The patients in the control group were subjected to conventional symptomatic medical treatment, gastrointestinal decompression, enteral nutrition by enema, and abdominal puncture drainage, etc. On the basis of treatments given in the control group, the patients in early hemofiltration treatment group were subjected to early hemofiltration. The APACHE-Ⅱ and Balthazar CT scores within one week were observed, and morbidity and mortality were recorded. Results At 3rd day after admission, the APACHE- Ⅱ score in early hemofiltration group were significantly lower than those in the control group. At 7th day after admission, CT examination was done, and the Balthazar scores in early hemofiltration group were significantly lower than in the control group. The incidence of complications and mortality in early hemofiltration group were significantly lower than in the control group at 7th day after treatment. Conclusions Early hemofiltration can reduce the incidence of complications and mortality in SAP,and is one of the effective treatments for SAP.

关 键 词：重症急性胰腺炎 血液滤过 

分 类 号：R657.51[医药卫生—外科学]