间断短时血滤对重症急性胰腺炎的影响及适应证探讨  

The effect and the indications of intermittent short veno-venuous hemofiltration in severe acute pancreatitis

作　　者：陶京[1] 王春友[1] 杨智勇[1] 俞建雄[1] 陈立波[1] 熊炯昕[1] 周峰[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科中心,湖北武汉430022

出　　处：《中国普通外科杂志》2003年第9期646-649,共4页China Journal of General Surgery

摘　　要：目的　探讨间断短时血滤 (ISVVH )对重症急性胰腺炎 (SAP)的疗效及其适应证。方法　将APACHEII评分≥ 14分和出现液体负平衡分别作为血滤 (HF )的重要适应证和最终停滤指征之一 ,对符合指征的 3 9例患者 ,行ISVVH治疗 19例 (IS组 ) ,未行HF的 2 0例 (N组 )作对比。观察各时点的APACHEII评分 ,BalthazarCT积分及血浆降钙素原 (PCT ) ,TNF α ,IL 6,IL 8,IL 1ra ,IL 2 ,IL 10的水平。结果　APACHEII评分在入组后 1d和入组时 ,IS组为 (13 .8± 3 .1)分和 (17.8± 3 .2 )分 ,第 4和第 10天 ,IS组为 (6.1± 1.6)分和 (1.8± 0 .9)分 ,N组为 (12 .6± 3 .2 )分和 (7.4±2 .7)分 ;PCT半定量变化与APACHEII评分变化相似 ;CT积分在入组 2周 ,IS组和N组为 (5 .1± 0 .8)分和 (8.1± 1.3 )分 ;各数值组间均有显著差异 (P <0 .0 5 )。与N组比较 ,IS组TNF α ,IL 6水平在第 4,10天低于N组 ,IL 2 ,IL 10在第 10天高于N组 ,(均为P <0 .0 5 ) ,第 10天时IS组抗促炎细胞因子比值亦明显增高。N组中转手术 1例 ,死亡 3例 ,平均入组后 (5 .9± 1.8)d出现液体负平衡 ;IS组无中转手术和死亡病例发生 ,平均入组后 (2 .7± 1.4)d出现液体负平衡。结论　SAP早期ISVVH治疗有利于减轻和缩短SIRS反应 ,控制病情 ,提高疗效。Objective Observe the effect and the indications of intermittent short veno-venuous hemofiltration(ISVVH) in severe acute pancreatitis(SAP). Methods APACHE II scores≥14 and fluids imbalance were respectively used to define as the indication of starting hemofiltration and ending hemofiltration. In 39 patients with SAP,19 underwent ISVVH(IS group),and the other 20 patients were not accepted hemofiltration (N group). APACHE II scores, Balthazar CT grades and the plasma levels of procalitonin(PCT), TNF-α, IL-6, IL-8, IL-1ra, IL-2 and IL-10 were observed. Results At admission and 2d after admission, APACHE II scores in IS group and N group were (13.8±3.1)and (17.8±3.2) ( P < 0.05 ). At 4 and 10 days after admission, the scores in IS group were (6.1±1.6) and (1.8±0.9) in N group were (12.6±3.2) and (7.4±2.7) (all P <0.05).The changs of semi-quantitation of PCT was similar to that of APACHE II scores. At two weeks after admission, the CT grades in N group and IS group were (5.1±0.8)and (8.1±1.3)( P <0.05). At 4d and 10d after admission , The level of plasma TNF-α, IL-6 in IS group was significant lower than that in N group( P <0.05);and the level of plasma IL-2, IL-10 in IS group was significant higher than that in N group ( P <0.05); and at 10d after admission . The anti- and pro- cytokines ratio in IS group was obviously higher than that in N group. In N group,3 patients died, 1 patient converted to laparotomy, and the fluids imbalance occurred at (5.9± 1.8 ) days after admission. In IS group, no patients died or converted to laparotomy, and the fluids imbalance occurred at (2.7±1.4) days after admission. Conclusion Early ISVVH can reduce SIRS and shorten SIRS period in patients with SAP.

关 键 词：胰腺炎/治疗 急性病 血液过滤 

分 类 号：R576[医药卫生—消化系统] R459.5[医药卫生—内科学]