CVVH治疗重症急性胰腺炎的临床研究

The clinical study of continuous veno-venous hemofiltration in treatment of severe acute pancreatitis

目的:探讨连续性静脉-静脉血液滤过(CVVH)治疗重症急性胰腺炎(SAP)的疗效和机制。方法:21例SAP患者中心静脉置管建立血管通路,使用AV600聚砜膜滤器,发病后2.8±1.4天行CVVH治疗,CVVH平均持续44.6±30.7h。比较CVVH前后患者临床症状、体征、生化指标、细胞因子的变化。结果:CVVH治疗过程中患者血流动力学状态稳定,ICU存活率76.2%。与CVVH前比较,CVVH治疗后腹痛腹胀症状明显减轻,体温、心率、呼吸次数明显降低,动脉血氧分压(PaO2)和氧合指数(PaO2/FiO2)明显提高(P均<0.05)。血BUN、Cr、AST、ALT、AMY、LPS均明显下降(P均<0.05)。CVVH结束时细胞因子TNF-αI、L-6、γ-INF均明显下降,与治疗前比较差异十分显著(P<0.01)。结论:应用CVVH治疗SAP疗效肯定,CVVH不仅能迅速减轻SAP患者的局部症状和体征,而且更重要的是能阻断全身炎症反应,改善氧合和组织氧代谢,缩短病程,改善预后。CVVH的这些重要治疗作用可能与外周血中TNF-α、IL-6、γ-INF等炎症介质的有效清除有关。

Objective ：To explore the efficacy and mechanism of continuous veno- venous hemofihration in treatment of severe acute pancreatitis（SAP）. Methods ：21 consecutive patients with SAP were included in this study. They were administrated with central venous catheteration. AV600 hemofiher（ 1 . 4m^2 ） was applied for CVVH. CVVH was started 2.8 ± 1.4 days after onset of disease and sustained for 44.6±30.7 hour. We monitored the changes of symptorm, physical sign, laboratory examination and cytokines during CVVH. Results ： The hemodynamic state in all patients was stable during CVVH. The overall surviral rate in ICU reached to 76.2 %. After implement of the CVVH treatment, abdominal pain and abdominal distension were considerably improved. Temperature, heart rate, breath rate decreased significantly, as well as serum concentrations of BUN, Cr, ALT, ALP, AMY, LPS declined. There was a considerable reduction in eytokines including TNF-α、IL-6、γ-INF at the end of C VH treatment. Conclusion ：CVVH is an effective therapeutic option in treatment of SAP. The early clearance of inflammatory mediators including TNF-α、IL-6、γ-INF is thought to be an important mechanism for improving outcome.