CRRT治疗高脂血症重症急性胰腺炎的疗效观察

Effects of continuous renal replacement therapy on severe acute pancreatitis with hyperlipidemia

目的观察连续性肾脏替代治疗(CRRT)高脂血症重症急性胰腺炎(HLSAP)的效果。方法回顾分析2006年1月至2009年12月收治的26例HLSAP患者,分为A、B两组。A组为16例予传统胰腺炎治疗联合肝素、胰岛素、降脂药治疗,B组10例除予传统胰腺炎治疗联合肝素、胰岛素、降脂药治疗外,加用CRRT治疗。比较两组住院时与治疗48 h后APACHEⅡ评分、TG、C反应蛋白(CRP),血、尿淀粉酶(AMS)水平,以及两组患者并发症、病死率等。结果 A组患者治疗48 h后APACHEⅡ评分、TG、CRP,血、尿AMS水平均无明显下降(P>0.05);B组治疗48 h后APACHEⅡ评分、TG、CRP明显下降(P<0.05),而血、尿AMS水平无明显改变(P>0.05)。A组患者中急性呼吸衰竭、急性肾衰竭、胸腹腔积液等并发症的发病率及病死率均明显高于B组(P<0.05)。结论 CRRT是治疗HLSAP首选方案之一,可显著改善HLSAP患者的临床症状及其预后。

Objective To observe the effects of continuous renal replacement therapy（CRRT） for hyperlipoidemia severe acute pancreatitis（HLSAP）.Methods The clinical data of 26 patients with HLSAP divided into A,B groups from January 2006 to december 2009 were analyzed retrospectively in the study.A group including 16 patients were treated with general management combined with heparin,insulin,lipid-lowering medication,B group of 10 patients were treated with continuous renal replacement therapy in addition to the general management combined with heparin,insulin,lipid-lowering drug treatment.The score of acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）,the levels of serum triglyceride,C-reactive protein,serum and urine amylase before treatment and after 48 hours therapy were compared,the same to the cases mortality and complications.Results The APACHEⅡ score,serum triglyceride,C-reactive protein level of A group after 48 hours therapy were not significantly decreased（P0.05）,that of B group after 48 hours therapy decreased significantly（P0.05）.Both of the two groups were no significant changes in serum and urine amylase（P0.05）.A group of acute respiratory failure,acute renal failure,pleural effusion and mortality were significantly higher than group B（P0.05）.Conclusion CRRT is the better way to HLSAP.It can significantly improve the clinical symptoms and reduce mortality of HLSAP