CVVH对重症急性胰腺炎器官损害保护作用的临床观察

Clinical Observation of Protective Effect of Continuous Venovenous Hemofiltration on Organ Damage in Severe Acute Pancreatitis

目的探讨连续性静脉-静脉血液滤过(CVVH)对重症急性胰腺炎(SAP)所致组织器官损害的保护作用。方法34例SAP患者分为对照组(16例)采用常规综合治疗,CVVH组(18例)在常规综合治疗的同时早期进行CVVH治疗。记录两组患者治疗后的急性肺损伤或急性呼吸窘迫综合征(ALI/ARDS)、急性肾功能衰竭(ARF)、胰性脑病、MODS、休克的发生率和治愈率及两组的病死率,并记录分析CVVH过程中的的生命体征、氧合指标、血流动力学等资料。结果CVVH治疗组对组织器官的保护作用、脏器功能衰竭发生率或治愈率均优于对照组(P<0.05),应用CVVH后,患者体温、脉搏下降,氧合指数(PaO2/FiO2)和肺泡-动脉氧差(AaDO2)得以改善,肺毛细血管楔压(PCWP)、体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)均有不同程度的改善,并能维持血流动力学的稳定。结论CVVH在重症急性胰腺炎早期治疗时可以明显缓解急性反应期的临床症状,对组织器官的损害起到较好的保护作用,提高非手术治愈率。

Objective To explore the protective cffecets of continuous venovenous hemofiltration （CVVH） on organ damage induced by severe acute pancreatitis （SAP）. Methods Thirty four cases with SAP were divided into CVVH group （ n= 18） and control group （ n = 16）. Patients in the control group were treated with routine treatment, while patients in the CWH group with early CVVH additionally. The incidence ratio of acute lung injure or adult respiratory distress syndrome （ALI/ ARDS）, acute renal failure （ ARF）, pancreatic encephalopathy, muhiple organ dysfunction syndrome （MODS） and shock, the curative ratio and the mortality in the two groups were detemined at one time. The indes such as vital signs, oxygen metabolism and hemodynamics were observed during the operation. Results The incidence ratio of organ functions failure was lower, the treatment effect was better and the curative ratio of was higher in the CVVH group compared with the control group （P〈 0.05）. The temperature and pulse of patients descended, the PaO2/FiDO2, AaDO2, PCWP, SVRI and PVRI wcrc all improved to some extent, and the steadiness of haermodynamics was maintained in the CVVH group. Conclusions The early CVVH treatmcnt can alleviate clinical sign obviously in acute reactive period , and has a significant protective effect against organ damage in SAP patients. CVVH can raise the curative ratio of non - operation therapy.