连续静-静脉血液透析滤过在重症急性胰腺炎治疗中的内环境稳态维持作用

Application of continuous veno-venous hemodiafiltration in the treatment of acute severe pancreatitis to maintain the stable state of internal environment

目的研究早期应用连续静-静脉血液透析滤过(CVH)治疗重症急性胰腺炎时的内环境稳态维持机制。方法 58例重症急性胰腺炎患者,33例作为实验组使用CVH治疗,25例作为对照组接受内、外科综合治疗。两组分别在治疗开始0、24、72h检测肿瘤坏死因子、白细胞介素1、2、6(IL-1、IL-6、IL-2)、血肌酐、血清胆红素、血淀粉酶、尿淀粉酶、尿素氮。结果实验组33例,治愈28例,3例患者因多器官衰竭死亡,2例因其他原因自动出院,其他患者在治疗时耐受好,治疗过程中无出血或严重低血压。对照组25例,治愈20例,4例患者死亡,1例因其他原因自动出院。两组血清内细胞肿瘤坏死因子、IL-6含量在治疗后24h与治疗前比较均显著降低(P<0.01),而实验组较对照组下降更明显(P<0.05);治疗后72h,与对照组相比,实验组患者IL-1、IL-2显著降低(P<0.05),血清胆红素、血淀粉酶、尿淀粉酶、尿素氮指标显著下降(P<0.05),血肌酐显著下降(P<0.01)。结论 CVH在重症急性胰腺炎治疗中的早期应用是维持重症胰腺炎患者内环境的有效手段。

Objective To study the efficacy and mechanisms of continuous veno-venous hemofiltration （CVH） in treatment of severe acute pancreatitis. Methods 58 cases of severe acute pancreatitis patients were enrolled： 33 patients treated with CVH, as the experimental group; 25 patients received comprehensive medical treatment as a control group. At the time points of 0, 24, 72 h during the treatment, two groups＇ tumor necrosis factor （TNF）, interleukin-1, 2, 6 （IL-1, IL-2, IL-6）, serum creatinine, serum bilirubin Su, serum amylase, urine amylase, blood urea nitrogen were detected accordingly. Results Among 58 patients, 28 cases were cured, 3 patients died in the experimental group because of multiple organ failure, and 2 patients were discharged for other reasons. The other patients tolerated the treatment well and there was no bleeding during the treatment of imbalance symptoms and no serious hypotension as well. Among 25 cases of the control group, 20 cases were cured, 4 patients died, 1 patient left the hospital for other reasons, compared with before, after 24 h treatment serum cytokines＇ TNF, IL-6 levels of the two groups were significantly lower （P 〈0.01）, and they decreased more significantly in the experimental group （P 〈0.05） than in the control group; compared with the control group, after 72 h treatment, CVH patients＇ IL-1, IL-2 decreased significantly （P 〈0.05）, and their sermn bilirubin Su, serum amylase index decreased significantly （P 〈0.05）, and still their serum creatinine also decreased significantly （P 〈0.01）. Conclusion The early application of CVH in the treatment of severe acute pancreatitis is an effective means to rescue one of severe acute pancreatitis.