摘要
目的观察腹膜透析治疗急性重症胰腺炎(severe acute pancreatitis,SAP)的疗效。方法分析我院2004年1月-2013年12月收治的SAP患者36例,腹膜透析组(治疗组)21例患者给予腹膜透析治疗,非透析组(对照组)15例给予药物治疗或外科手术治疗等,比较两组腹部症状缓解时间,呼吸机脱机时间,血、尿淀粉酶正常时间,Balthazar CT积分,APACHEII积分,外周血中IL-6、PCT、CRP治疗后各时相水平,以及住院费用、治愈率、死亡率、并发症发生率。结果腹膜透析组的腹部症状缓解时间(16.08±4.32天比30.16±14.33天,t=4.261,P=0.000)、呼吸机脱机时间(8.50±2.65天比18.66±6.56天,t=6.429,P=0.000)、血淀粉酶正常时间(13.5±5.93天比25.68±11.36天,t=4.193,P=0.0002)、尿淀粉酶正常时间(13.92±6.96天比28.77±12.67天,t=4.516,P=0.0001)均短于对照组,治疗组Balthazar CT积分在治疗7、14天(5.33±0.67比7.95±0.53,t=12.577,P=0.000和2.08±0.16比7.19±0.32,t=63.188,P=0.000)均低于对照组,APACHEII积分在治疗后1、3、5、7天(8.98±2.95比13.05±3.56,t=3.744 P=0.000;7.06±1.84比12.44±3.06,t=6.581,P=0.000;5.09±1.06比10.98±2.73,t=9.021 P=0.0001;3.16±0.74比9.18±1.96,t=12.9054,P=0.000)均低于对照组,治疗组治疗1、3、7天后IL-6(122.02±89.86ng/L比286.47±238.62ng/L,t=2.89,P=0.006;109.86±78.05ng/L比254.83±210.26ng/L,t=2.905,P=0.0064;44.24±18.43ng/L比186.54±145.27ng/L,t=4.464,P=0.0001)、PCT(11.00±6.22ng/L比18.86±12.19ng/L,t=2.538,P=0.016;5.56±3.12ng/L比15.89±9.88ng/L,t=4.509,P=0.000;1.65±0.93ng/L比10.39±5.77ng/L,t=6.856,P=0.000)、CRP(96.39±44.13 ng/L比120.14±44.53 ng/L,t=2.068,P=0.022;82.14±38.98ng/L比108.82±41.71 ng/L,t=2.626,P=0.037;46.90±22.24 ng/L比89.45±40.58 ng/L,t=4.043,P=0.000)明显低于对照组,住院时间(33.42±12.27天比58.16±14.38天,t=5.553,P=0.000)、住院费用(13.71±4.93万元比28.54±15.26万元,t=4.1791,P=0.000)明显低于对照组,并发症发生率(14.29%比40.00%,χ2=6.722,P=0.024)、死亡率(0比46.67%,χ2=6.030
Objectives To evaluate the efficacy of peritoneal dialysis （PD） in the treatment of severe acute pancreatitis （SAP）. Methods Thirty-six SAP patients treated in our hospital from January 2004 to Decem- ber 2013 were randomly divided into two groups, PD group （n=21） in which patients were treated with PD, and non-PD group （control group, n=15） in which patients were treated with drugs or surgery. The relief time of abdominal pain and abdominal distension, the time of respiration without mechanical ventilation, the recov- ery time of serum amylase and urine amylase levels, scores of Balthazar CT and APACHE II, changes of in- flammatory cytokines including IL-6, PCT and CRP after treatment, length and expense of hospitalization, and recovery rate were compared between the 2 groups. Results In PD group, the relief time of abdominal pain and abdominal distension, the time of independent respiration without mechanical ventilation, and the re- covery time of serum amylase and urine amylase were significantly lower than those in control group 06.08± 4.32 days vs. 30.16±14.33 days, t=4.261, P=0.000 for the relief time of abdominal pain and abdominal disten- sion; 8.50±2.65 days vs. 18.66±6.56 days, t=-6.429, P=0.000, for the time of independent respiration without mechanical ventilation; 13.5±5.93 days vs. 25.68±11.36 days, t=4.193, P=0.000, for serum amylase; 13.92± 6.96 days vs. 28.77± 12.67 days, t=4.516, P=0.0001, for urine amylase）; Balthazar CT scores after the treat-ment for 7 and 14 days were significantly lower than those in control group （5.33±0.67 vs. 7.95±0.53, t= 12.577, P= 0.000, after treatment for 7 days; 2.08±0.16 vs. 7.19±0.32, t=63.188, P=0.000, after the treatment for 14 days）; APACHE II scores after the treatment for 1, 3, 5, and 7 days were also significantly lower than those in control group （8.98±2.95 vs. 13.05±3.56, t=3.744, P= 0.000, after the treatment for one day; 7.06± 1.84 vs. 12.44±3.06, t=6.5813, P= 0.0001, after the treatment for 3 days; 5.09±1.06 vs
出处
《中国血液净化》
2015年第2期100-104,共5页
Chinese Journal of Blood Purification
关键词
腹膜透析
重症胰腺炎
Peritoneal dialysis
Severe acute pancreatitis
