早期连续性肾脏替代治疗联合血液灌流对急性重症胰腺炎患者肺功能及预后的影响  

Influence of continuous renal replacement therapy combined with hemoperfusion on the pulmonary function and prognosis of patients with severe acute pancreatitis

作　　者：马舰 赵智[2] 杜昌[3] Ma Jian;Zhao Zhi;Du Chang.(Department of Emergency, the Hospital of Changping District, Beefing 102200, China;Department of Department of Emergency,the People＇s Hospital of Peking University ,Beijing 100044, China)

机构地区：[1]北京市昌平区医院急诊科,北京市102200 [2]北京市昌平区医院ICU,北京市102200 [3]北京大学人民医院急诊科,北京市100044

出　　处：《中国基层医药》2018年第7期890-894,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 观察早期连续性肾脏替代治疗（CRRT）联合血液灌流（HP）对急性重症胰腺炎（SAP）患者肺功能及预后的改善作用。方法 选取SAP患者62例为研究对象，采用随机数字表法分为CRRT组31例、CRRT＋HP组31例，比较两组患者治疗后的急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）发生率、病死率、血氧分压（PaO2）、氧合指数（PaO2/FiO2）及肿瘤坏死因子α（TNF-α）、白细胞介素18（IL-18）。结果 CRRT＋HP组ALI/ARDS发生率为22.58%（7/31）、病死率6.45%（2/31），CRRT组分别为51.61%（16/31）、25.81%（8/31），两组差异均有统计学意义（χ2＝5.599、4.292，均P〈0.05）。治疗后，CRRT＋HP组PaO2、PaO2/FiO2分别为（85.9±7.6）mmHg、（245.8±35.6）mmHg，均高于CRRT组的（69.8±9.4）mmHg、（198.6±31.2）mmHg（t＝5.912、5.314，均P〈0.05）；CRRT＋HP组TNF-α、IL-18分别为（11.95±0.67）ng/L、（325.87±84.17）ng/L，均低于CRRT组的（17.32±0.54）ng/L、（441.08±72.97）ng/L，两组差异均有统计学意义（t＝5.174、6.771，均P〈0.05）。结论 HP联合CRRT能够改善SAP患者的肺功能及预后。bjective To study the influence of continuous renal replacement therapy（CRRT）combined with hemoperfusion（HP）on the pulmonary function and prognosis of patients with severe acute pancreatitis（SAP）.Methods 62 patients were chosen as study objects,and they were divided into CRRT group（31 cases）and CRRT＋ HP group（31 cases）according to the digital table.After treatment,the incidence rate of acute liver injury（ALI）/ acute respiratory distress syndrome（ARDS）,mortality,PaO2,PaO2/FiO2,tumor necrosis factor α（TNF-α）and IL-18 levels were compared.Results The incidence rate of ALI/ARDS and mortality in the CRRT＋ HP group were 22.58%（7/31）and 6.45%（2/31）,respectively,which in the CRRT group were 51.61%（16/31）,25.81%（8/31）,respectively,the differences between the two groups were statistically significant（χ2=5.599,4.292,all P〈0.05）.After treatment,the PaO2 and PaO2/FiO2 of the CRRT＋ HP group were（85.9±7.6）mmHg and（245.8±35.6）mmHg,respectively,which were higher than those of the CRRT group[（69.8±9.4）mmHg,（198.6±31.2）mmHg]（t=5.912,5.314,all P〈0.05）.The TNF-α and IL-18 levels of the CRRT＋ HP group were（11.95±0.67）ng/L and（325.87±84.17）ng/L,respectively,which were lower than those of the CRRT group[（17.32±0.54）ng/L,（441.08±72.97）ng/L],and the differences were statistically significant（t=5.174,6.771,all P〈0.05）.Conclusion CRRT combined with HP can alleviate pulmonary function and prognosis of patients with SAP.

关 键 词：肾替代疗法 血液灌注 胰腺炎 急性坏死性 呼吸功能试验 预后 

分 类 号：R576[医药卫生—消化系统]