短期腹腔灌洗对重症急性胰腺炎的治疗价值

Therapeutic Efficacy of Short-term Peritoneal Lavage in Patients with Severe Acute Pancreatitis

背景:重症急性胰腺炎(SAP)是一种病情凶险、并发症多、死亡率高的急腹症,早期腹腔灌洗可清除渗出的炎性细胞因子等,提高SAP的治愈率。目的:观察短期腹腔灌洗对SAP的疗效。方法:选取57例SAP患者,其中26例伴有明显腹膜刺激征或穿刺腹腔有渗液的患者行腹腔灌洗,31例未行腹腔灌洗者作为对照组。腹腔灌洗在起病3天内进行,并持续约3～7天。对SAP患者腹腔灌洗前后的APACHE鄄Ⅱ积分、血清C反应蛋白(CRP)水平进行比较,并评估并发症发生和临床指标改善情况。结果:SAP患者行腹腔灌洗后,APACHE鄄Ⅱ积分由14.4±6.5降至8.1±2.4(P<0.01),血清CRP水平由272.4mg/L±51.6mg/L降至65.3mg/L±11.5mg/L(P<0.01),且较对照组基础治疗后下降更为显著(P<0.05和P<0.01)。腹腔灌洗组患者的腹痛缓解时间亦较对照组显著缩短(1.1天±0.5天对3.2天±1.4天,P<0.05)。结论:短期腹腔灌洗能明显改善SAP患者的一般情况和炎症反应,改善患者的预后,值得在临床上推广应用。

Background: Severe acute pancreatitis (SAP) is an acute abdomen, runing a critical course with many complications and high mortality rate. Early peritoneal lavage may be useful in the elimination of inflammatory cylokines in the peritoneal extravasation which can improve the cure rate of SAP. Aims: To investigate the effects of short-term peritoneal lavage on SAP. Methods: Fifty-seven SAP patients were enrolled, and 26 patients with peritoneal irritation or peritoneal extravasation were chosen for peritoneal lavage, 31 patients received routine treatment only were taken as the control group. The procedure was carried out 3 days after onset of the disease for 3～7 days. The APACHE-Ⅱscores and serum C-reactive protein (CRP) level of SAP patients were compared before and after peritoneal lavage. The complications and clinical indices were also assessed. Results: After peritoneal lavage, the APACHE-Ⅱ score of SAP patients decreased from 14.4±6.5 to 8.1±2.4 (P<0.01), the level of serum CRP from 272.4 mg/L±51.6 mg/L to 65.3 mg/L±11.5 mg/L (P<0.01), both were markedly lower than those of the control group (P<0.05 and P<0.01). The time for abdominal pain relief was significantly short in the peritoneal lavage group than that in the control group (1.1 days±0.5 days vs 3.2 days±1.4 days) (P<0.05). Conclusions: Short-term peritoneal lavage can improve the patients' general condition decrease the inflammatory response and improve the outcome of SAP, which worths recommendation for wider use.