持续高流量血液滤过对重症急性胰腺炎伴多器官功能障碍综合征的治疗作用  

Effect of high-volume continuous veno-venous haemofiltration on severe acute pancreatitis with multiple organ dysfunction syndrome

作　　者：李维勤[1] 季大玺[2] 全竹富[1] 王浩[1] 龚德华[2] 何长生[1] 谢红浪[2] 虞文魁[1] 叶向红[1] 刘芸 汪志明[1] 赵允召[1] 李为苏[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院全军普通外科研究所SICU,210002 [2]南京军区总医院全军肾脏病研究所

出　　处：《中国实用外科杂志》2003年第9期549-551,共3页Chinese Journal of Practical Surgery

基　　金：江苏省社会发展基金资助项目 (BS2 0 0 0 0 5 1)

摘　　要：目的　观察持续高流量血液滤过 (HVHF)对重症急性胰腺炎 (SAP)伴多器官功能障碍综合征(MODS)的治疗作用。方法　 1997～ 2 0 0 2年 2 8例SAP伴MODS接受了HVHF治疗。APACHEⅡ评分为(14 36± 3 96 )分 ,BalthazarCT评分为 (8 5± 1 4 )分。从发病到开始HVHF时间 (6 0± 6 1)d ,HVHF治疗时间为 (4 0 4± 3 99)d。置换液以前稀释方式输入 ,流量为 4 0 0 0mL/h ,血流量 2 5 0～ 30 0mL/min ,连续 2 4h不间断。滤器为AN6 9膜 ,面积 1 2m2 ,每 2 4h更换 1次。采用低分子肝素抗凝。结果　 2 8例病人中 ,2 0例治愈出院 ,2例因经济原因放弃治疗 ,6例死亡 (2 1 4 % )。HVHF后体温、心率和呼吸频率显著降低 ;APACHEⅡ评分显著下降(14 4± 3 9vs 9 9± 4 3,P <0 0 1) ;动脉血氧分压显著提高 (6 8 5± 19 5vs 91 9± 2 5 0 ,P <0 0 1)。所有病人均良好耐受HVHF治疗 ,HVHF过程中血流动力学稳定 ,未发现明显的副作用。结论　对SAP伴MODS的病人 ,HVHF明显改善体温、心率、呼吸频率、APACHEⅡ评分和动脉血氧分压。HVHF过程中血流动力学稳定 ,可能成为重要的辅助治疗措施。Objective To investigate the effect of high-volume continuous hemofiltration (HVHF) in severe acute pancreatitis(SAP)with multiple organ dysfunction syndrome(MODS).Methods Twenty-eight SAP patients with MODS underwent HVHF from 1997 to 2002,the APACHE Ⅱ score of the patients was 14.36±3.96,and the CT severity score was 8.5±1.4.HVHF was started (6.0±6.1)days after onset of disease and sustained for (4.04±3.99)days.The ultrafiltration rate during HVHF was 4L/h,blood flow rate was 250～300mL/min,and the substitute fluid was infused with pre-dilution.AN69 hemofilter (1.2m\+2) was changed every 24 hours.Low-molecular-weight heparin was used as anticoagulant.Results Among 28 patients,20 were cured,6 died,the mortality being 21.4%.After HVHF,the temperature,heart rate,respiratory rate decreased obviously.The APACHE Ⅱ score decreased significantly after HVHF(14.4±3.9 vs 9.9±4.3,P<0.01).The PaO\-2 increased markedly from (68.5±19.5)mmHg before HVHF to (91.9±25\^0)mmHg after HVHF(P<0.01).HVHF were well tolerated in all the patients.The haemodynamic variables were stabilized during HVHF.No obvious side-effect relate to HVHF was found.Conclusion In SAP patiens with MODS,HVHF can improve the temperature,the heart rate,the respiratory rate,the APACHE Ⅱ score,and the PaO\-2 markedly.HVHF may become one of the assistant therapies to improve the outcome.

关 键 词：持续高流量血液滤过 重症急性胰腺炎 多器官功能障碍综合征 治疗 并发症 

分 类 号：R657.51[医药卫生—外科学] R59[医药卫生—临床医学]