简易腹腔灌洗联合早期血液滤过治疗重症急性胰腺炎

Simple peritoneal lavage combined with venous-venous hemofiltration for severe acute pancreatitis

目的探讨简易腹腔灌洗联合早期血液滤过治疗重症急性胰腺炎（SAP）的临床效果。方法以腹腔穿刺针穿刺入腹腔，连接三通管，滴入生理盐水1000ml，然后排出，如此反复3次。之后滴入利多卡因、地塞米松及抗生素，每日一次，直至灌洗液由血性变清亮。同时行床旁血液滤过。结果按随机数字表法将61例SAP患者分为腹腔灌洗＋血液滤过组（治疗组，31例）和对照组（30例）。治疗组腹痛缓解、腹胀缓解、恶心呕吐消失及腹膜刺激征消失天数分别为（1．5±0．3）d、（2．7±0．3）d、（1．9±0．3）d、（1．5±0．2）d，住院天数为（11．0±2．0）d，显著短于对照组的（3．9±0．3）d、（4．5±0．6）d、（3．7±0．2）d、（5．3±0．4）d、（18．0±2．5）d（P值均〈0．05）。治疗组治疗后1d起，血ALT及AST浓度较对照组显著下降；3d起血、尿淀粉酶及TNF-α、IL-6、IL-8含量较对照组显著下降，血HCO3^-、IL-10含量显著增高（P〈0．05或〈0．01）；5d起血尿素氮、肌酐含量较对照组显著下降（P〈0．05）。结论腹腔灌洗联合早期血液滤过能及时清除炎性因子，对于SAP的治疗更合理、有效。

Objective To investigate the effectiveness of simple peritoneal lavage combined witil venous-venous hemofiltration therapy for severe acute pancreatifis （SAP）. Methods Needles were inserted into abdominal cavity and tee was connected, then normal saline was administrated and discharged, followed by lidocaine, dexamethasone and antibiotics once daily until bloody peritoneal drainage became clear. At the same time venous-venous hemofiltration was used. Results 61 SAP patients were randomly divided into peritoneal lavage ＋ hemofiltration group （treatment group, n = 31 ） and control group （n = 31 ）. The time to abdominal pain relief, abdominal distention relief, nausea and vomiting disappearance, peritoneal irritation disappearance was （1.5±0.3）d,（2.7±0.3）d, （1.9±0.3）d, （1.5±0.2）d, and the time to cure was （11.0±2.0）din the treatment group, which was significantly shorter than that in the control group [ （ 3.9± 0.3 ） d, （4.5 ± 0.6）d, （3.7±0.2）d, （5.3±0.4）d, （18.0±2.5）d, P〈0.051. At the lst day of treatment, sermn ALT, AST was significantly lower than that in the control group; at the 3rd day of treatment, the serum and urine amylase and serum levels of TNF-α, IL-6 and IL-8 level were significantly lower, but the serum level of IL-10, HCO3 was significantly higher than that in the control group （P 〈 0.05 or 〈 0.01 ） ; at the 5th day of treatment, the serum Bun and Cr level were significantly lower than those in the control group （P 〈 0.05）. Conclusions Simple peritoneal lavage combined with venous-venous hemofiltration therapy can effectively eliminate the inflammatory factors, which is more rational and effective for the treatment of severe acute panereatitis.