早期持续高容量血液滤过治疗重症急性胰腺炎的临床研究

A clinical study of early continuous high-volume-hemof＇fltration in the treatment of severe acute pancreatitis

目的研究早期持续高容量血液滤过（HVHF）对重症急性胰腺炎（SAP）患者的临床疗效。方法以2005年1月至2011年7月南昌大学第一附属医院重症医学科收治的SAP患者60例为研究对象，随机分为血液滤过（血滤）组和对照组，血滤组在采用常规治疗方法的同时，使用HVHF进行早期干预，比较两组患者的腹部症状、生命体征、氧合指数、肝肾功能、急性生理与慢性健康（APACHEⅡ）评分变化。结果与对照组相比，血滤组早期HVHF治疗后患者发热、心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解，APACHEⅡ评分[（13．3±1．0）分比（14．1±1．2）分]、血TBil[（20．4±11．3）μmoL／L比（28．1±10．9）μmoL／L]、血肌酐[（178．7±71．8）μmoL／L比（215．6±51．3）μmoL／L]、血尿素氮[（10．1±5．6）mmol/L比（13．2±3．8）mmol/L]、血ALT[（51．3±13．2）U／L比（62．5±14．3）U／L]均显著下降（P值均〈0．05），氧合指数（PaO2／FiO2）（197．3±32．4比178．3±31．7）有显著提高（P〈0．05），且在血滤治疗过程中患者平均动脉压逐渐上升，心率逐渐下降，与对照组相比差异有统计学意义（P〈0．05）。结论早期持续性HVHF治疗SAP能早期缓解症状，改善病情，阻止全身炎症反应综合征发展为多器官功能障碍综合征；并能改善脏器功能，减少并发症，在SAP早期治疗中具有重要地位。

Objective To evaluate the efficacy of early continuous high-volume-hemofiltration in the treatment of patients with severe acute pancreatitis （SAP）. Methods Based on the method of prospective, randomized and controlled clinical trial, 60 patients with SAP between January 2005 and July 2011 from the First Affiliated Hospital of Nanchang University were divided into control group and hemofiltration group. The hemofiltration group was treated with early continuous high-volume-hemofiltration and not in the control group. The changes of vital signs, clinical symptoms and laboratory indicators were compared between the two groups before and after the treatment. Results After hemofiltration, the clinical symptoms such as abdominal pain, fever, tachycardia and respiratory distress in hemofiltration group were significantly remitted compared to those in the control group （P 〈0. 05）. The APACHE Ⅱ score （ 13.3 ± 1.0 vs 14. 1 ± 1.2） and the level of TBil [ （ 20.4 ± 11.3 ） μmol/L vs （ 28. 1 ± 10. 9 ） μmol/L ], creatinine [ （ 178.7 ± 71.8 ） μmol/L vs （215.6 ± 51.3 ） μmol/L], blood urea nitrogen[ （ 10.1 ± 5.6） mmoL/L vs （ 13.2 ± 3.8） mmol/L] and ALT[ （51.3 ± 13.2） U/L vs （62.5 ± 14.3） U/L] were decreased compared to those in the control group （ all P values 〈 0. 05 ）. The level of PaO2/FiO2 （ 197.3±32.4 vs 178. 3 ± 31.7 ） was increased （P 〈 0. 05 ）. After hemofihration, heart rate was decreased gradually （P 〈 0. 05 ） in the hemofiltration group than in the control group. Mean artery pressure （mAP） increased gradually （P 〈 0. 05 ） in the hemofiltration group than in the control group. Conclusion Early continuous high-volume- hemofiltration has significant effects on the treatment of SAP including the improvement of clinic symptoms,the blockade of development from systemic inflammatory response syndrome （SIRS） to multiple organ dysfuction syndrome（MODS） ,improvement of organ function and prevention from the complications. It may become one of the important therapies for SAP.