早期间断短时血液滤过联合腹膜透析对重症急性胰腺炎患者炎症因子的影响

Effect of Early Intermittent Short-time Veno-venuous Hemofiltration and Continuous Cyclic Peritoneal Dialysis on Severe Acute Pancreatitis

【目的】探讨早期间断短时血液滤过联合腹膜透析对重症急性胰腺炎（SAP）患者炎症因子的影响。【方法】对符合条件的65例（SAP）患者随机分为试验组和对照组，对照组予常规非手术治疗；试验组在对照组基础上早期予间断短时血液滤过和腹膜透析。观察两组的APACHE1I评分变化、肿瘤坏死因子α（TNFα）、白细胞介素6（IL-6）和白细胞介素8（IL-8）的变化及其临床疗效。【结果】试验组35例患者中32例好转，存活率91．4％（32／35）；对照组30例中22例SAP缓解，存活率73．3％（22／30）。试验组腹痛消失时间、腹胀缓解时间均较对照组显著缩短；试验组APACHEⅡ评分下降明显，各相应时点和对照组比较差异均有显著性；试验组治疗后血液中TNFα、IL-6、IL-8促炎细胞因子较治疗前显著降低，较对照组也显著降低；腹膜透析液中这些促炎细胞因子较治疗前显著降低。【结论】早期间断短时血液滤过联合腹膜透析在治疗重症急性胰腺炎，可起协同、互补的作用，对SAP有着良好的治疗效果，值得临床重视。

[Objective] To explore the curative effect of early intermittent short-time veno-venuous hemo- filtration（ISVVH） and continuous cyclic peritoneal dialysis（CCPD） on severe acute pancreatitis. [Methods] Sixty five cases with severe acute pancreatitis were randomly divided into the experiment group and control group. The control group was treated with routine non-operation methods and the experiment group was treated with routine non-operation methods and ISVVH combined with CCPD. The APACHE Ⅱ score, cytokine and curative effect were compared between two groups. [Results]The survival rate of experiment group was 91.4% which was significantly higher than that of control group（73. 3%）. For the experiment group, the stomachache extinction time and abdominal distension relief time reduced significantly. Each phase＇s APACHE Ⅱ score was lower, the concentration of TNF-α, IL-6 and IL-8 in blood were also lower than those of the control group. After the treatment with ISVVH and CCPD, the concentrations of TNF-α, IL-6 and IL-8 in blood or peritoneal dialysis fluid decreased day by day. [Conclusion] Early ISVVH combined with CCPD has satisfactory therapeutic efficacy on severe acute pancreatitis. It can cooperate and complement each other, and should be paid attention in clinics.