连续性血液净化治疗18例重症急性胰腺炎的临床分析

Therpy of continuous blood purification in severe acute panreatitis:reports of 18 cases

目的:探讨连续性血液净化(CBP)治疗对重症急性胰腺炎(SAP)的临床疗效。方法:分析我院自2003年～2009年18例SAP患者行CBP的疗效,其中3例合并多器官功能衰竭(MOF),15例合并多器官功能障碍综合征(MODS),其中13例合并有肾功能衰竭;治疗前后评估APACHEⅡ评分,检测临床生化指标、血清中肿瘤坏死因子(TNF-α)、白细胞介素-2(IL-2)的结果。结果:18例SAP患者存活17例,死亡1例;17例患者预后良好,经CBP治疗后APACHEⅡ评分明显下降(P<0.01),生命体征明显好转;生化指标下降明显(P<0.05);血TNF-α和IL-2均显著下降(均P<0.05)。结论:在药物治疗的基础上,配合CBP治疗可以清除炎症介质,改善心、肺、肝、肾等器官的功能,以维持内环境的稳定,为临床治疗SAP提供一种新手段。

Objective：To study the clinical effect of continuous blood purification（CBP） on severe acute panre atitis （SAP）.Methods：18 patients were all come from the hospital.Three patients with SAP complicated with multiple organ failure （MOF）,15 patients with SAP complicated with multiple organ dysfunction syndrome （MODS）.Thirteen patients of MODS were complicated with acute renal failure（ARF）.The patients underwent CBP in the early stages（2～5days）.Baxter BM25 was used to do CBP（parameter exchange fluid 2.5-4L/h,blood fluid 180-300ml/min and blood filter membrane HF1200）.Tumor necrosis factor-α （TNF-α） and interleukin-2 （IL-2） were detected before and after CBP treatment.Results：According to the standards of SAP,18 cases from different department of the hospital were recruited in the study,3 of them were accompanied with MOF,15 had MODS.They were treated with CBP 2-8 times with 6-18 hours each time.After treatment with CBP,17 cases were alive while 1 was dead.APACHE score were apparently decreased.TNF-α and IL-2 also decreased. Conclusion：CBP treatment could clear TNF-α and IL-2 to prevent patients from MOF and MODS and keep stability of inner environment and is a new supplementary treatment on SAP patients.