连续性血液净化对重症急性胰腺炎患者胃黏膜酸度的影响

Influence of continuous blood purification on gastric mucosal pH in severe acute pancreatitis patients.

目的观察连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者胃黏膜酸度的影响。方法选择SAP患者20例,随机分为CBP治疗组和非CBP治疗对照组各10例,两组均在治疗前、治疗第2天、4天和6天测定其胃黏膜pH值(pHi)及动脉血乳酸值。结果两组患者初始pHi均值均偏低,CBP组患者治疗后第4天和第6天pHi水平较治疗前明显升高,且差异有显著性(分别为P<0.05和P<0.01),对照组治疗前后pHi水平未见显著改变。两组间比较,治疗第4天和第6天,CBP组pHi水平显著高于对照组(分别为P<0.05和P<0.01)。CBP组在治疗第2天乳酸值即开始显著下降(P<0.05),治疗第6天乳酸值下降最为显著(P<0.01);对照组治疗前后乳酸值无显著改变(P>0.05);与对照组比较,治疗后第2天和第4天CBP组乳酸水平显著降低(P<0.05),第6天降低最为明显(P<0.01)。结论应用CBP治疗可提高SAP患者pHi,并降低患者乳酸代谢水平,改善患者胃肠道的微循环灌注及氧合。

Objective To evaluate the influence of continuous blood purification (CBP) on gastric mucosal pH (pHi) and arterial blood lactate levels in SAP patients. Methods Twenty SAP patients were divided into CBP group and non-CBP control group randomly. pHi and arterial blood lactate were measured before therapy and at 2,4 and 6 days after therapy in both groups. Results Before therapy, pHi value decreased to a certain extent in patients of both groups, and increased significantly at 4 d and 6 d in CBP group as comparison to that before therapy(P < 0. 05 and P < 0. 01, respectively), meanwhile there was no significant change in the control group. In addition, pHi value was much higher in CBP group than that in the control group at 4 d and 6 d(P < 0. 05 and P < 0. 01, respectively). In CBP group, arterial blood lactate levels decreased significantly at 2 d compared to the value before therapy (P < 0. 05), and the declination was most significant after therapy for 6 d (P < 0. 01), but the value changed little in the control group. It was much lower in CBP group than that in the control group after therapy for 2 d and 4 d (both P < 0. 05), and the decrease was most significant after therapy for 6 d (P < 0. 01). Conclusions CBP therapy can significantly elevate pHi value and decrease blood lactate level, suggesting that CBP therapy can improve gastrointestinal blood perfusion and oxygenation.