多种血液净化联合治疗重症急性胰腺炎32例

Combined use of different blood purification methods to treat severe acute pancreatitis: an analysis of 32 cases

目的:探讨多种血液净化联合治疗重症急性胰腺炎的疗效和机制.方法:29例接受内科综合治疗患者为对照组,32例在内科综合治疗基础上增加血液净化(包括连续性高容量血液滤过、血液灌流及腹膜透析)为治疗组,观察2组治疗效果.结果:治疗组在腹痛缓解、腹水淀粉酶下降、APACHEⅡ评分及CT严重度指数多项指标均比对照组好转恢复快;预后对照组治愈好转21例(占72.41%),死亡8例(占27.59%),治疗组治愈好转29例(占90.63%),死亡3例(占9.38%).差异有统计学意义(P<0.05或0.01).结论:血液净化治疗重症急性胰腺炎疗效明显,可迅速改善患者病情,降低死亡率;对病情特别严重患者,采用连续性高容量血液滤过、血液灌流及腹膜透析联合治疗效果更佳.

AIM： To investigate the efficacy of combined use of different blood purification methods in the treatment of severe acute pancreatitis （SAP） and explore the therapeutic mechanisms involved. METHODS： Sixty-one SAP patients were randomly divided into control group （n = 29） and treatment group （n = 32）. Patients in the control group underwent conventional therapy, while those in the treatment group underwent conventional therapy and blood purification [including continuous high-volume hemofiltration （CHVHF）, hemoperfusion （HP）, and peritoneal dialysis （PD）]. The efficacy was compared between the two groups. RESULTS： Compared with the control group, the duration of abdominal pain relief was significantly shortened, ascitic amylase level was significantly reduced, and APACHE II score and CT severity index （CTSI） were significantly improved in the treatment group. The response rate achieved in the control group was significant lower than that in the treatment group （72.41% vs 90.63%, P 〈 0.05）, while the mortality rate in the control group was significant higher than that in the treatment group （27.59% vs 9.38%, P 〈 0.01）. CONCLUSION： Blood purification can rapidly improve clinical symptoms and reduce mortality rate in SAP patients, and is therefore effective for treatment of SAP. Combined use of CHVHF, HP and PD has better efficacy in the treatment of extremely severe cases of SAP than either method alone.