摘要
目的:观察高容量血液滤过(HVHF)治疗重症急性胰腺炎(SAP)的临床疗效,评价其在SAP治疗中的作用,探索治疗SAP的新方法.方法:采用回顾性对照临床研究,将我院2004-12/2008-12因SAP住院治疗的患者45例分为2组:对照组24例,HVHF组21例.所有患者均符合2004年中国急性胰腺炎诊治指南(草案)中SAP的诊断标准,发病后48h内入院,经CT证实均无明确胆道梗阻.自动生化检测仪检测2组SAP患者治疗前后血清淀粉酶及肾功能、常规检测血常规、CRP等,记录生命征、腹部症状并统计并发症及死亡率.结果:与对照组相比,HVHF组患者的APACHEⅡ评分明显降低,治疗第3天与第7天HVHF组显著低于对照组(6.6±1.5vs9.9±2.5,3.4±1.1vs6.4±2.0,均P<0.05);局部症状与体征缓解时间明显缩短,HVHF组腹痛缓解时间较对照组明显缩短(51±16hvs71±34h,P<0.05);腹部压痛缓解时间与对照组相比也显著缩短(71±16hvs102±34h,P<0.05);血尿淀粉酶指标、WBC、CRP及肾功能生化指标明显好转;并发症发生率和死亡率均降低(14.3%vs37.5%,4.8%vs20.8%,均P<0.05);平均住院时间显著缩短(P<0.05);住院费用无明显增加.结论:HVHF能迅速减轻SAP患者腹部症状与体征,改善器官功能,显著改善预后,其机制可能通过阻断SAP早期全身炎症反应综合征.
AIM：To evaluate the efficacy of high-volume hemofiltration（HVHF）in the treatment of severe acute pancreatitis（SAP）and explore new methods for treatment of SAP. METHODS：A retrospective controlled study was performed.Forty-five SAP patients treated at our hospital were divided into two groups： control group（n=24）and HVHF group（n= 21）.All patients were diagnosed according to the draft criteria for diagnosis and treatment of acute pancreatitis in China.No bile duct obstruction was found by CT scan.Patients in the two groups were subjected to tests for serum and urine amylase,WBC,CRP and hepatic and renal function.The vital signs and abdominal symptoms and signs were recorded.The complications and mortality were analyzed. RESULTS：After three and seven days of therapy,the APACHE（acute physiology and chronic health evaluation）II scores in the HVHF group were significantly lower than those in the control group（6.6±1.5 vs 9.9±2.5 and 3.4±1.1 vs 6.4 ±2.0,respectively;both P0.05）.Compared to the control group,the serum and urine amylase, WBC,CRP and hepatic and renal function were improved significantly,the mortality and complication rates were significantly reduced（14.3% vs 37.5%and 4.8%vs 20.8%,respectively;both P〈0.05）,and the durations of abdominal pain relief（71±34 h vs 51±16 h,P0.05）and abdominal tenderness relief（102±34 h vs 71±16 h,P〈0.05）as well as the average duration of hospital stay were significantly shortened in the HVHF group（P0.05）.No significant difference was found in the cost of hospitalization between the two groups. CONCLUSION：HVHF can rapidly reduce abdominal symptoms and signs,improve organ function and prognosis and reduce mortality in SAP patients perhaps through attenuation of the systemic inflammatory response syndrome in the early stage of the disease.
出处
《世界华人消化杂志》
CAS
北大核心
2009年第23期2379-2384,共6页
World Chinese Journal of Digestology
关键词
重症急性胰腺炎
全身炎症反应综合征
高容量血液滤过
Severe acute pancreatitis Systemic inflammatory response syndrome High-volume hemofiltration
