连续性肾脏替代治疗联合限制性液体复苏在重症急性胰腺炎治疗中的应用价值  

Application value of continuous renal replacement therapy combined with restricted fluid resuscitation in treatment of severe acute pancreatitis

作　　者：邢继丹 张佳[1] 胡嘉欣 XING Ji-dan;ZHANG Jia;HU Jia-xin(Depatement of EICU,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊重症监护病区(EICU),郑州450000

出　　处：《医药论坛杂志》2024年第23期2528-2531,2536,共5页Journal of Medical Forum

摘　　要：目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)采用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合限制性液体复苏的临床效果。方法选取2020年2月至2023年11月郑州大学第一附属医院收治的SAP患者192例,将其随机分为研究组和对照组各96例,对照组接受限制性液体复苏治疗,研究组在对照组基础上接受CRRT治疗,比较两组疗效。结果研究组总有效率95.83%高于对照组77.08%,差异有统计学意义(P<0.05);两组治疗前乳酸脱氢酶(L-lactate dehydrogenase,LDH)、脂肪酶(lipase,LIPA)及血清淀粉酶(serum amylase,AMS)水平比较,差异无统计学意义(P>0.05);治疗3 d后均降低,研究组AMS、LIPA、LDH水平分别是(153.58±14.56)U/L、(264.52±25.43)U/L及(183.42±18.95)U/L,均低于对照组,差异有统计学意义(P<0.05);两组治疗前C反应蛋白(C-Reactive protein,CRP)、白细胞介素-7(interleukin-7,IL-7)及单核细胞趋化因子-1(monocyte chemoattractant protein-1,MCP-1)比较,差异无统计学意义(P>0.05);治疗3 d后均降低,研究组CRP、IL-7、MCP-1水平分别是(76.12±16.13)mg/L、(37.21±3.42)ng/L及(20.14±3.02)pg/mL,均低于对照组,差异有统计学意义(P<0.05);治疗期间,研究组并发症发生率8.33%低于对照组29.17%,差异有统计学意义(P<0.05)。结论CRRT联合限制性液体复苏治疗SAP效果明显,可改善胰腺功能,减轻炎症反应,且安全性高,值得临床推广。Objective To investigate the application value of continuous renal replacement therapy(CRRT)combined with restricted fluid resuscitation in the treatment of severe acute pancreatitis(SAP).Methods In this prospective study,192 SAP patients admitted to the First Affiliated Hospital of Zhengzhou University from February 2020 to November 2023 were randomly divided into the control group and the study group.The control group received restricted fluid resuscitation therapy,and the study group received CRRT therapy on the basis of the control group to compare the efficacy.Results The total effective rate of the study group was 95.83%higher than that of the control group 77.08%(P<0.05).The levels of serum amylase(AMS),lipase(LIPA)and lactate dehydrogenase(LDH)in 2 groups before treatment were compared(P>0.05).The levels of AMS,LIPA and LDH in the study group were(153.58±14.56)U/L,(264.52±25.43)U/L and(183.42±18.95)U/L,respectively,which were lower than those in the control group(P<0.05).CRP,IL-7 and MCP-1 were compared between the two groups before treatment(P>0.05).The levels of C-reactive protein(CRP),interleukin-7(IL-7)and monocyte chemokine-1(MCP-1)in the study group were(76.12±16.13)mg/L,(37.21±3.42)ng/L and(20.14±3.02)pg/mL,respectively.It was lower than group control(P<0.05).During the period treatment,the rate of complication the group study was 8.33%lower than group control 29.17%(P<0.05).Conclusion CRRT combined with restricted fluid resuscitation in the treatment of SAP has obvious effects,can improve pancreatic function,reduce inflammation,and is safe,worthy of clinical promotion.

关 键 词：重症急性胰腺炎 连续性肾脏替代治疗 限制性液体复苏 炎症 

分 类 号：R657.5[医药卫生—外科学]