血液灌流联合连续性静脉-静脉血液滤过治疗重症急性胰腺炎临床观察

Effect observation of hemoperfusion combined with continuous veno-venous hemofiltration on treatment of patients with severe acute pancreatitis

目的探讨血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)治疗重症急性胰腺炎(SAP)的临床疗效。方法选择本院2011年1月—2013年6月我院急诊重症监护室(EICU)收治的16例SAP患者,给予常规治疗同时予HP联合CVVH治疗,观察治疗后临床指标的动态变化及治疗效果。结果治疗24 h后患者体温、心率、呼吸、平均动脉压(MAP)、血肌酐(Cr)、尿素氮(BUN)、血淀粉酶(AMS)、血清C反应蛋白(CRP)及APACHEⅡ评分均较治疗前明显改善,差异有统计学意义(P<0.05);PO2、WBC计数在治疗48 h后较治疗前明显改善,差异有统计学意义(P<0.05);16例SAP患者中12例患者最终好转出院,死亡4例,死亡率为25.0%。结论 HP联合CVVH治疗SAP可有效清除炎症介质,减轻全身炎症反应,并遏制由此引起炎性介质对机体组织器官的再次损害,改善患者的临床症状,是治疗SAP的有效措施。

Objective To explore the effect of hemoperfusion（HP） combined with continuous veno-venous hemofiltration （CVVH） on treatment of patients with severe acute pancreatitis （SAP）. Methods 16 patients with SAP were treated with combination therapy of conventional treatment plus HP and CVVH. Efficacy and dynamic changes of clinical indicators were observed after treatment. Results After 24 hours, the temperature, heart rate, respiration, MAP, serum creatinine, blood urea nitrogen, AMS, CRP and APACHE Ⅱ score were significantly better than those before treatment（P 〈 0.05）. The PO2, WBC count improved significantly after 48 hours （P 〈 0.05）. In all of the 16 patients, 12 patients discharged finally, 4 patients died, and the mortality rate was 25.0 % ; Conclusion For patients with SAP, combination therapy of conventional treatment plus HP and CVVH can clear inflammatory mediators, improve clinical symptoms and hold back the damages on tissues and organs caused by inflammatory mediators, so it is an effective measure for the treatment of SAP.