连续性肾脏替代疗法治疗重症急性胰腺炎的临床观察

Clinical observation of continuous renal replacement therapy in patients with severe acute pancreatitis

目的观察连续性肾脏替代疗法(CRRT)治疗重症急性胰腺炎(SAP)患者的疗效及预后。方法回顾性分析广西医科大学第一附属医院ICU 2006年5月～2012年2月收治的22例SAP患者的临床资料,比较CRRT治疗前,治疗后3、5、7天患者生命征,APACHEⅡ评分及白细胞、SCr、血AMS、血气等变化,记录腹部症状并统计并发症及死亡率。结果 22例患者死亡4例,死亡率18.20%。22例患者均有急性肾损伤;急性肺损伤/急性呼吸窘迫综合征/肺部感染发生率为81.82%,其中胸腔积液50%;MODS 45.45%;感染性休克13.64%;急性肝损伤、胰性脑病均为9.09%;DIC、ACS均为4.55%。与治疗前相比,CRRT治疗3天后,T、RR、WBC、血AMS、血乳酸、APACHⅡ评分均下降(P<0.05),pH升高(P<0.05);5天后,脉搏、SCr、CRP均下降(P<0.05),PaO2/FiO2升高(P<0.05)。3～5天后临床症状及体征改善。MAP呈下降趋势,但差异无统计学意义(P>0.05)。结论 CRRT能快速有效改善SAP患者病情,稳定生命征、改善血气分析指标、清除体内代谢毒素,入住ICU的SAP患者及早进行CRRT的效果较好。

Objective To observe the effect and prognosis of continuous renal replacement therapy（CRRT） in severe acute pancreatitis（SAP）.Methods Clinical data of 22 cases with SAP admitted to the department of intensive care unit of the first affiliated hospital of Guangxi Medical University from May 2006 to February 2012 were reviewed retrospectively.The pre-and post-treatment 3 days,5 days and 7 days vital sign,APACH Ⅱ score,white blood cell count,biochemistry indicator and blood gas analysis were compared.The abdominal symptoms were recorded and complications and mortality were statistic analysis.Results Three patients died which contained twenty-two patients,the mortality rate was 18.20 percent.Twenty-two patients were suffered from AKI.ALI/ARDS/Pulmonary infection were 81.82 percent,50 percent of them suffered from pleural effusion.MODS was 45.45 percent.Septic shock was 13.64 percent.Both acute liver injury and pancreatic encephalopathy were 9.09 percent.DIC and abdominal compartment syndrome were 4.55 percent.Compared with the pre-treatment,the temperature,respiratory rate,WBC count,serum AMS,blood lactate and APACHⅡ score were decreased significantly after three days CRRT（P0.05）.Conclusion CRRT can effectively improve the patient’s condition with SAP and promote stability of the vital sign,improve blood gas indicators,clear the metabolic toxin.The SAP patients admitted to ICU will get better treatment effect when they are treated early by CRRT.