早期高容量血液滤过治疗重症急性胰腺炎伴急性呼吸窘迫综合征患者的效果  

Effect of Early High Volume Hemofiltration in Patients with Severe Acute Pancreatitis and Acute Respiratory Distress Syndrome

作　　者：罗宁 许明 郑亮 倪荣 孙敏敏 杨桦 韩双双 芦乙滨 LUO Ning;XU Ming;ZHENG Liang;NI Rong;SUN Minmin;YANG Hua;HAN Shuangshuang;LU Yibin(Department of Critical Medicine,Xinyang Central Hospital,Xinyang 464000,China)

机构地区：[1]信阳市中心医院重症医学科,河南信阳464000

出　　处：《河南医学研究》2021年第32期6006-6009,共4页Henan Medical Research

基　　金：信阳市软科学研究项目(20190055)。

摘　　要：目的探讨早期高容量血液滤过(HVHF)治疗重症急性胰腺炎(SAP)伴急性呼吸窘迫综合征(ARDS)患者的效果。方法选取2016年1月至2019年12月信阳市中心医院重症医学科诊治的SAP伴ARDS患者82例,以随机数字表法分为对照组(41例)与研究组(41例),对照组接受基础治疗,研究组在对照组的基础上接受HVHF治疗。比较两组治疗前、治疗24 h、治疗48 h、治疗72 h的降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素10(IL-10)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平,比较两组治疗前后第1秒钟用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)占预计值百分比(FEV_(1)%),比较两组机械通气时间、28 d死亡率、ICU住院时间、总住院时间。结果研究组治疗24、48、72 h后血清PCT、CRP、IL-10、IL-16、TNF-α水平均较治疗前降低,对照组治疗72 h后上述血清指标较治疗前降低,且研究组低于对照组,差异有统计学意义(P<0.05)。两组治疗后FEV_(1)、FCV、FEV_(1)/FCV较治疗前升高,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组机械通气时间、ICU住院时间、总住院时间低于对照组,差异有统计学意义(P<0.05);研究组28 d死亡率为19.51%,与对照组(34.15%)比较,差异无统计学意义(P>0.05)。结论对SAP伴ARDS患者实施早期HVHF治疗,可有效降低炎症因子水平,缩短机械通气时间和住院时间,改善预后,有助于患者的恢复。Objective To investigate the effect of early high volume hemofiltration(HVHF) in patients with severe acute pancreatitis(SAP) and acute respiratory distress syndrome(ARDS).Methods A total of 82 SAP patients with ARDS who were diagnosed and treated in critical medicine department of Xinyang Central Hospital from January 2016 to December 2019 were selected and divided into control group(41 cases) and study group(41 cases) by random number table method.The control group received basic treatment and the study group received HVHF treatment on the basis of the control group.The procalcitonin(PCT),C reactive protein(CRP),interleukin 10(IL-10),interleukin 6(IL-6),tumour necrosis factor α(TNF-α) before treatment and 24 h treatment,48 h treatment,72 h treatment were compared between the two groups.Forced expiratory volume in one second(FEV_(1)),forced vital capacity(FVC),FEV_(1) as a percentage of predicted value(FEV_(1)%) before treatment and after treatment were compared between the two groups.The two groups of mechanical ventilation time,28 day mortality,ICU hospitalization time,total hospital stay were compared.Results Serum PCT,CRP,IL-10,IL-16,and TNF-α levels in the study group after 24,48,and 72 h treatment were lower than before treatment,the control group after 72 h treatment were lower than before treatment,the study group after treated 24,48,72 h were lower than the control group,and the differences were statistically significant(P<0.05).After treatment,the FEV_(1),FCV,FEV_(1)% of the two groups were higher than before treatment,and the study group was higher than the control group,the differences were statistically significant(P<0.05).The mechanical ventilation time,ICU hospitalization time,and total hospitalization time of study group were lower than those of the control group(P<0.05).The 28 day mortality in the study group was 19.51%,which was not statistically different from the control group(34.15%)(P>0.05).Conclusion Early high volume hemofiltration for patients with SAP and ARDS can effectively reduce

关 键 词：重症急性胰腺炎 急性呼吸窘迫综合征 早期高容量血液滤过 炎症因子 

分 类 号：R657.51[医药卫生—外科学]