腹腔穿刺灌洗联合持续肾替代治疗腹腔间隙综合征疗效观察

Effects of continuous renal replacement therapy combined with abdominal paracentesls lavage therapy on abdominal compartment syndrome

目的观察腹腔穿刺灌洗联合持续肾替代治疗（CRRT）与单纯腹腔穿刺灌洗治疗腹腔间隙综合征（ACS）效果。方法选择52例ACS患者，随机分成两组，对照组为单纯腹腔穿刺灌洗组，联合治疗组同时行CRRT治疗，比较两组治疗前、治疗24、48、72h后的急性生理和慢性健康状况评分（APACHEII评分）、炎症反应器官功能不全评分（IRODS）、血乳酸、BNP、TNF-α、降钙素原（PCT）、肝肾功能、禁食时间、膀胱压降至正常时间、ICU治疗时间及出院存活率的差异。结果联合治疗组治疗48h后以上各项指标均明显优于对照组，同时联合治疗组禁食时间、膀胱压降至正常时间和ICU治疗时间均明显短于对照组，出院存活率明显高于对照组。结论腹腔穿刺灌洗联合CRRT治疗较单纯腹腔穿刺灌洗治疗能更快、更有效地降低腹内高压、保护各脏器功能和提高存活率。

Objective To compare the effects of Continuous renal replacement therapy com- bined with Abdominal Paracentesis Lavage therapy with Abdominal Paracentesis Lavage therapy on Ab- dominal compartment syndrome （ACS）. Methods A total of 52 ACS patients were randomLy divided into two groups. Combination therapy group with 28 cases accepted CRRT and Abdominal Paracentesis Lavage therapy, and control group with 24 cases only accepted the Abdominal Paracentesis Lavage thera- py. The APACHE Ⅱ and IRODS score , the Blood lactic acid, BNP, TNF - or, PCT, the function of liv- er and Kidney before and after 24, 48, 72 hour treatment, the fasting time, the time of bladder pressure dropped to normal, length of ICU stay and survival rate of the two groups were compared.Results The scores of combination therapy group were significantly lower than those of control group after 48 - hour treatment, the fasting time, the time of bladder pressure dropped to normal and length of ICU stay of combination therapy group were shorter, and survival rate of combination therapy group was higer（P 〈 0. 05 ）. Conclusion CRRT combined with Abdominal Paracentesis Lavage therapy would rapidly, effectively reduce abdominal pressure, protect organ function, improve the survival rate.