早期持续高容量血液滤过对重症急性胰腺炎的治疗作用

Effect of early continuous high-volume hemofiltration on severe acute pancreatitis

目的研究早期持续高流量血液滤过(HVHF)对重症急性胰腺炎(SAP)的治疗作用。方法将45例SAP患者随机分成早期应用HVHF组(早期应用组,n=21)和常规应用HVHF组(对照组,n=24)。监测患者生命体征、血生化和血气指标,并进行APACHEⅡ和MOD评分。记录多器官功能障碍综合征(MODS)和感染的发生率以及死亡率,并对其进行生存分析。结果早期应用组患者入院第3、10天的APACHEⅡ及MOD评分均较入院时明显改善(P<0.05),而对照组至入院第10天才较入院时有所改善(P<0.05);并且在入院第3、10天,早期应用组均优于对照组患者(P<0.05)。早期应用组生命体征、血生化和血气指标改善均较对照组明显(P<0.05)。早期应用组的MODS和感染的发生率以及死亡率均低于对照组(P=0.006、P=0.041和P=0.033)。结论早期持续性HVHF治疗能明显改善脏器功能,维持内环境稳定,阻断全身炎症反应综合征向多器官功能障碍综合征(MODS)发展,降低病死率,可成为一项重要的辅助治疗措施。

【Objective】 To investigate the effect of early continuous high-volume hemofiltration（HVHF） on patients with severe acute pancreatitis.【Methods】 45 patients with SAP were included in the study and randomly divided into two groups： group Ⅰ（early continuous high-volume hemofiltration therapy group,n =21）,group Ⅱ（control group,n =24）.Blood biochemical indexes,gas analysis and vital sign were monitored.Meanwhile,APACHEⅡ and MOD scores were graded.The rats of multiple organ dysfunction syndrome（MODS）,infection and mortality were measured and analyzed during the study.【Results】 In group Ⅰ,the APACHEⅡ and MOD scores on the 3rd and 10th day after admission were significantly decreased compared to those on admission（P 〈0.05）.Meanwhile,in the group Ⅱ,the scores were not improved a little until the 10th day after admission（P〈 0.05）.And on the 3rd and 10th day after admission the scores in group Ⅰdecreased more significantly than those in group Ⅱ（P 〈0.05）.Blood biochemical indexes,gas analysis and vital sign in group Ⅰ improved more significantly than those in group Ⅱ（P 0.05）.At the end of the study,the rats of MODS,infection and mortality in group Ⅰ were significantly lower than those in group Ⅱ（P =0.006,P =0.041 and P =0.033）.【Conclusion】 Early continuous HVHF can improve prognosis of patients with severe acute pancreatitis and might become an important supplementary therapy..