APACHEⅡ评分对重症急性胰腺炎患者行高容量血液滤过治疗时机选择的价值

Timing of high-volume hemofiltration for patients with severe acute pancreatitis of different phases according to APACHEⅡ score

目的探讨以APACHEⅡ评分标准衡量高容量血液滤过(HVHF)治疗重症急性胰腺炎(SAP)的治疗时机以及对疗效的影响。方法回顾性分析解放军第324医院、西南医院、新桥医院自2006年1月至2011年12月行HVHF治疗的113例SAP患者,根据HVHF治疗前患者APACHEⅡ评分标准分A组(20～24分)、B组(25～29分)、C组(≥30分),按照APACHEⅡ评分标准作为HVHF治疗的时机,对比分析3组的病死率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间,并将HVHF治疗前和治疗24h后的APACHEⅡ评分和SOFA评分、血浆IL-1β值、氧合指数、血浆肌酐(Cr)值、平均动脉压(MAP)等结果进行比较。结果 (1)C组HVHF治疗前APACHEⅡ和SOFA评分、血浆IL-1β值及病死率均明显高于A、B两组(P<0.01),B组HVHF治疗前APACHEⅡ评分、血浆IL-1β值及病死率均明显高于A组(P<0.01);(2)B组平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间均明显长于A组(P<0.05);(3)3组HVHF治疗24h后血浆IL-1β值、氧合指数、Cr值、MAP均明显改善,但C组IL-1β值仍高于A、B两组(P<0.01),B组IL-1β值仍高于A组(P<0.01);A、B两组HVHF治疗24h后APACHEⅡ和SOFA评分显著降低(P<0.01),C组变化差异无统计学意义(P>0.05)。结论 HVHF对SAP有良好的辅助治疗效果;APACHEⅡ评分对HVHF的治疗时机有指导意义,早期(APACHEⅡ评分为20～29分)HVHF可明显改善SAP的预后,当APACHEⅡ评分20～24分时行HVHF的疗效更好。

Objective To analyze the efficacy of high-volume hemofiltration（HVHF） for patients with severe acute pancreatitis （SAP） at different phases according to APACHE Ⅱ score. Methods The clinical data of 1β patients with SAP,who were treated in No. 324 Hospital of PLA,Southwest Hospital and Xinqiao Hospital during Jan. 2006 to Dec. 2011, were retrospectively analyzed. All of them were divided into three groups：group A（20--24）,group B（25--29）,group C（≥30） according to APACHE Ⅱ score at which they received HVHF;the timing of HVHF was analyzed according to different phases of APACHE Ⅱ score. The morality rate in hospital,ICU length of stay,duration of total mechanical ventilation and the length of HVHF were compared among three groups. Their APACHEⅡ score, sequential organ failure assessment（SOFA） score, serum interleukin-1β（IL-1β） ,oxygenate index, blood urea nitrogen（BUN） ,serum creatinine（Cr） ,mean arterial pressure（MAP） were also compared before and after HVHF for 24 btours. Results （1）Before HVHF,APACHEH score,SOFA score,serum IL-1β and the mortality rate were higher in group C than those in group A and B（P〈0.01）;before HVHF,APACHEH score,serum IL-1β and the mortality rate were higher in group B than those in group A（P〈0.01）. （2）ICU length of stay,duration of total mechanical ventilation, the length of HVHF in group B were longer than those in group A（P〈0.05）. （3）After HVHF for 24 hours,serum IL-1β,oxygenate index,Cr and MAP improved significantly in all patients（P〈0.01） ,but serum IL 1β in group C was still higher than that in group A and B,serum IL-1β in group 13 was still higher than that in group A, APACHE Ⅱ and SOFA score decreased significantly in group A and B（P〈0.01）, but insig- nificantly in group C（P〉0.05）. Conclusion HVHF is an effective treatment for patients with SAP. APACHE Ⅱ score can help to guide the timing of HVHF. HVHF can remarkably improves the prognosis of patients with the phase of APACHE Ⅱscore for 20-- 29 ,with the best efficacy seen in patient with phase of APACHE Ⅱ score for 20--24.