CRRT对重症急性胰腺炎患者接受经皮引流治疗的影响:一项回顾性队列研究  

Effect of continuous renal replacement therapy during percutaneous drainage in severe acute pancreatitis patients: a retrospective cohort study

作　　者：孙博睿[1] 张春[2,3] 林婷[2,3] 刘司南[2,3] 王挣[2,3] 张靖垚[2,3] 刘昌 Sun Bond;Zhang Chun;Lin Ting;Liu Sinan;Wang Zheng;Zhang Jingyao;Liu Chang(Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China;Department oj Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China;Department of SICU, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China)

机构地区：[1]西安交通大学第一附属医院麻醉科,陕西西安710061 [2]西安交通大学第一附属医院肝胆外科,陕西西安710061 [3]西安交通大学第一附属医院SICU,陕西西安710061

出　　处：《中华危重病急救医学》2019年第6期714-718,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81773128).

摘　　要：目的评价连续性肾脏替代治疗(CRRT)在重症急性胰腺炎(SAP)患者接受经皮引流(PCD)治疗中的临床效果及安全性.方法回顾性分析2015年11月11日至2018年5月13日西安交通大学第一附属医院肝胆外科收治SAP接受PCD治疗患者的临床资料.依据是否接受CRRT治疗将患者分为CRRT组和对照组,比较两组患者基线资料,接受PCD治疗前后相关指标及并发症发生情况,以及结局和预后指标.结果共75例患者纳入研究,其中CRRT组30例,对照组45例.①两组患者在性别、年龄、体重指数(BMI)、既往史(吸烟、饮酒)、合并症(心血管疾病、慢性肺疾病、糖尿病、慢性肾功能不全)、病因(胆源性、酒精性、高脂血症性及其他),入院48 h内的白细胞计数(WBC)、C -反应蛋白(CRP)、降钙素原(PCT)水平,是否液体复苏、机械通气、使用血管活性药物及腹腔高压等方面差异均无统计学意义;而CRRT组入院48 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)显著高于对照组(分:18.3±4.5比12.8±6.2,P<0.05).②两组患者PCD前WBC、PCT、APACHEⅡ评分、CT严重指数(CTSI)评分差异均无统计学意义.两组引流位置、引流次数差异无统计学意义,但CRRT组PCD穿刺时间较对照组显著延长(d :19.4±5.4比12.8±2.2,P<0.05).两组PCD后相关指标,如引流液性状、腹腔出血、感染、消化道瘘、内镜坏死组织清除术、开腹坏死组织清除术及PCD至内镜或开腹手术时间差异亦无统计学意义,但CRRT组重症加强治疗病房(ICU)住院时间及总住院时间较对照组显著延长(d :23.2±8.5比15.3±12.1,51.2±21.2比31.2±14.0,均P<0.01).③ Kaplan-Meier生存曲线分析显示,CRRT组与对照组在1年和3年累积生存率方面差异无统计学意义(χ1^2=0.097,P1=0.755;χ2^2=0.013,P2=0.908).结论 CRRT在SAP接受PCD患者治疗中安全可行,且不增加出血风险,但可能会延迟PCD介入时机,从而延长ICU住院时间及总住院时间,值得临床医生关�Objective To evaluate the clinical efficacy and safety of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP) receiving percutaneous drainage (PCD). Methods Clinical data of SAP patients receiving PCD admitted to department of hepatobiliary surgery of the First Affiliated Hospital of Xi'an Jiaotong University from November 11th 2015 to May 13th 2018 were retrospectively analyzed. The patients were divided into CRRT group and control group according to whether or not receiving CRRT. Demographic data, relevant variables before and after PCD, complication and outcome were all compared. Results A total of 75 patients were included in the study, 30 were treated with application of CRRT and 45 without CRRT.① There was no significant difference in gender, age, body mass index (BMI), medical history (smoking, drinking), complications (cardiovascular disease, chronic lung disease, diabetes, chronic renal insufficiency), etiology (gallstone, alcohol abuse, hyperlipidemia and others), or white blood cell count (WBC), C-reactive protein (CRP), serum procalcitonin (PCT), fluid resuscitation, mechanical ventilation, vasoactive agent or intra-abdominal pressure within 48 hours after admission between the two groups. However, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within 48 hours after admission of CRRT group was significantly higher than that of control group (18.3±4.5 vs. 12.8±6.2, P < 0.05).② There was no significant difference in WBC, PCT, APACHEⅡ score or computed tomography severity index (CTSI) before PCD between the two groups. There was no significant difference in the position or times of PCD procedure between the two groups, but the time interval of PCD in the CRRT group was significantly longer than that in the control group (days: 19.4±5.4 vs. 12.8±2.2, P < 0.05). Meanwhile, there was no significant difference in drainage of fluid properties, incidence of abdominal bleeding, infection, gastrointestinal fistula, endoscopic removal of necro

关 键 词：连续性肾脏替代治疗 重症急性胰腺炎 经皮穿刺引流 

分 类 号：R576[医药卫生—消化系统]