早期呼吸机支持加床边血液滤过治疗急性重症胰腺炎

Clinical study on the therapeutic effects of mechanical ventilation combining with hemafiltration in the early period of acute severe pancreatitis

目的 :采用早期呼吸机支持加床边血液滤过治疗急性重症胰腺炎患者 ,探讨其对减轻肺、肝和肾损伤的疗效。方法 :对 17例急性重症胰腺炎患者 2 4小时内行呼吸机支持〔潮气量 (VT) 8m l/kg,呼气末正压(PEEP)通气 0 .49～ 0 .98k Pa(1k Pa=10 .2 0 cm H2 O)〕,并行床边连续静静脉血液滤过 (CVVH ) ,每次持续 6小时 ,连续 5日。结果 :与对照组比较 ,治疗组动脉氧分压 (Pa O2 )和氧合指数 (Pa O2 /Fi O2 )均有明显提高 (P均 <0 .0 5 ) ,血肌酐 (Cr)、尿素氮 (BU N)和丙氨酸转氨酶 (AL T)均有下降 (P均 <0 .0 5 ) ,乳酸值未见明显增高 ,肺顺应性 (Cst)稳定在 3.0～ 3.3m l/k Pa(31～ 34 m l/cm H2 O)。结论 :早期床边血液滤过治疗急性重症胰腺炎可明显减轻肺。

Objective:To explore the therapeutic effects of mechanical ventilation combining with hemafiltration on lung?liver and kidneys of acute severe pancreatitis in the early period.Methods:seventeen patients of acute severe pancreatitis were ventilated〔tidal volume(VT)8 ml/kg,positive and expiratory pressure(PEEP)0 49～0 98 kPa(1 kPa=10 20 cmH 2O)〕.At the same time,continuous venousvenous hemafiltration(CVVH) was lasted for five days,each time was for six hours.Results:Compared with control group,PaO 2 and PaO 2/FiO 2 were increased markedly(both P <0 05),while creatinine(Cr),blood urea nitrogen(BUN) and alanine aminotransferase(ALT) were decreased obviously(all P <0 05).The level of lactate was no significant change.Lung compliance static(Cst) was kept in 3 0～3 3 ml/kPa(31~34 ml/cmH 2O).Conclusions:Mechanical ventilation combining with CVVH can protect against lung,liver and kidneys dysfunction in the early period of acute severe pancreatitis.