短时静-静脉血液滤过在小儿重症 急性胰腺炎治疗中的应用

Short term venous-venous hemofiitration in severe acute pancreatitis in children

目的 探讨短时静-静脉血液滤过（SWH）在小儿重症急性胰腺炎治疗中的策略和疗效。方法 将我院2006年5月至2010年5月收治的27例小儿重症急性胰腺炎患儿按治疗方法分为常规治疗组（A组）和常规治疗＋SVVH组（B组），对其血液滤过参数、临床疗效、并发症和住院费用进行统计分析。结果 治疗后3d与治疗前相比，在A组内，WBC（20．5±3．8）×10^9／L比（14．3±2．7）×10^9／L、AMS（781．6±187．5）U／L比（603．2±113．1）U／L、BUN（11．1±2．7）mmol／L比（8．4±1．8）mmol／L、CRP（294．5±37.7）mg／L比（171．5±34．5）mg／L、血Ca^2^＋（1．6±0．4）mmol／L比（2．2±0．2）mmol／L、Na^＋浓度（128．0±6．0）mmol／L比（137．1±2．9）mmol／L及PaO2（73．9±12．1）mmHg比（85．2±5．3）mmHg等方面差异具有统计学意义（P〈0．01），UAMY（2606．9±963．9）U／L比（1782．2±878．0）U／L的差异具有统计学意义（P〈0．05）；在B组内，WBC（20．1±4．8）×10^9／L比（9．4±3．2）×10^9／L、AMS（815．8±186．9）U／L比（280．1±93．9）U／L、UAMY（2706．1±961．2）U／L比（948．2±719．7）U／L、BUN（11．3±1．7）mmol／L比（5．2±2．4）mmol／L、CRP（301．9±48．7）mg／L比（87．3±34．2）mg／L、血Ca^2^＋（1．8±0．4）mmol／L比（2．3±0．1）retool／L、Na^＋浓度（127．0±6．7）mmol／L比（140．3±3．0）mmol／L及PaO2（74．7±10．4）mmHg比（93．3±5．7）mmHg，差异均有统计学意义（P〈0．01），K’（5．5±1．5）mmol／L比（4．5±0．6）mmol／L的差异具有统计学意义（P〈0．05）；两组间在治疗后3d相比，WBC（14．3±2．7）×10^9／L比（9．4±3．2）×10^9／L、AMS（603．2±113．1）U／L比（280．1±93．9）U／L、BUN（8．4±1．8）mmol／L比（5．2±2．4）mmol／L及CRP（171．5±34．5）mg／L比（87．3±34．2）mg／L，差异具有统计学意义（P〈O．01），在血UAMY（1782．2±878．0）U／L比（948．2±719．7）U／L、Ca^2^＋（2．2±0．2）mmol／L比（2．3±0．1）mmol／L、Na^＋浓度（137．1±2．9）mmol／L比（140．3±3．0）mmol／L和PaO2（85．2±5．3）mmHg比（93．3±5．7）mmHg间的差异具有统计学意义（_P〈0．05），而血K^＋浓度（4．9±1．0）mmol／L比（4．5±0．6）mmol／L的差异无统计学意义（P〉O．05）。两组在腹痛缓解时间、AMS恢复正常时间、住院天数和住院费用上差异有统计学意义（P〈O．01），治疗效果、治疗3d后John评分上的差异也有统计学意义（P〈0．05）。结论 药物联合早期SVVH治疗小儿急性胰腺炎效果满意。

Objective To review the strategy and therapeutic effect of short term venous-venous hemofihration （SVVH） in the treatment of severe acute pancreatitis （SAP） in children. Methods Thirty-nine children with SAP hospitalized between May 2006 and May 2010, were treated with two therapeutic strategies; routine management （Group A） and routine combined with SVVH treatment （Group B）. The biochemical indicators, clinical effects, complications, cost and hospitalization duration were analyzed retrospectively. Results Comparing the data at the onset with those after threedays therapy, the biochemical indicators including WBC counts, AMS, UAMY, BUN, CRP, Ca2＋ , Na＋ and PaO2 significantly improved in group A （P〈0. 01）. In group B, all the biochemical indicators （WBC Counts, AMS, UAMY, BUN, CRP, Ca2＋ , K＋ , Na＋ , PaO2） showed statistically significant differences （P〈0. 05）. Between the two groups, some of the day 3 results, including WBC, AMS, CRP, showed significant differences （P〈0. 01）. The level of UAMY, Ca2＋, Na＋ and PaO2 also showed statisticcal differences （P〈0. 05）, but there were no difference in K＋ （P〉0. 05）. With respect to the disappearance of abdominal pain and return to normal of AMS, the cost and hospitalization, the differences between the two groups was significant （P〈0. 01） Treatment effects and John＇s scoring on day 3 also demonstrated statistically significant differences （P〈0. 05）. Conclusions The strategy of routine combined with SVVH is a viable treatment for severe acute panereatitis of children.