脉冲式高容量血液滤过治疗重症急性胰腺炎的疗效观察

Efficacy of pulse high-volume hemofiltration in treatment of severe acute pancreatitis

目的观察脉冲式高容量血液滤过(PHVHF)治疗重症急性胰腺炎(SAP)的疗效。方法对2004年7月至2008年12月苏州大学附属第四人民医院收治的16例SAP患者在接受传统治疗方法的同时行PHVHF治疗,观察治疗前后临床症状、急性生理学及慢性健康状况评价Ⅱ(APACHⅡ)评分、生化指标的改变以及对愈后的影响。结果PHVHF治疗后,SAP患者腹痛、腹胀、发热、心动过速、呼吸窘迫等症状明显改善,APACHⅡ评分由治疗前15.93±3.06降至8.56±2.87(P<0.01),血清淀粉酶、转氨酶、肌酐、白细胞等均有下降,低氧血症、酸中毒纠正(P<0.01)。16例患者中14例存活,病死率为12.5%。结论PHVHF治疗SAP效果显著,降低病死率,可以作为SAP的重要辅助治疗。

Objective To observe the efficacy of pulse high-volume hemofiltration （PHVHF） in treatment of severe acute pancreatitis（SAP）. Methods Sixteen patients with SAP were involved, PHVHF was performed. During PHVHF, the patients＇ conditions were observed. Blood biochemistry, acute physiology and chronic health evaluation Ⅱ （APACH Ⅱ ） score were detected as well. We also observed the effects on mortality. Results After PHVHF,the clinical symptoms such as abdominal pain,fever,tachycardia and respiratory distress wre remitted. The APACH Ⅱ score decressed significantly pre-PHVHF： 15.93 ± 3.06, post-PHVHF： 8. 56 ± 2. 87 （ P 〈 0. 01 ）. The level of serum amylase, alanine transaminase （ALT） , serum ereatinine（Scr） and white blood cell（ WBC ） were decreased（ P 〈 0.01 ） , acidosis and hypoxemia were corrected（P 〈0. 01 ）. 14 patients of 16 survived,the mortality rate was 12. 5%. Conclusion PHVHF has significant effects on the treatment on the SAP,and reduces the mortality. PHVHF may become one of the assistant therapies of the SAP.