持续低效血液透析滤过治疗重症急性胰腺炎

Treatment effect of sustained low-efficiency diafiltration on patients with severe acute pancreatitis

目的评价持续低效血液透析滤过（SLEDF）对重症急性胰腺炎（SAP）的治疗价值。方法将42例SAP患者随机分为持续静脉一静脉血液滤过（CVVH）组和SLEDF组，在常规治疗的基础上分别接受CVVH和SLEDF治疗。观察两组患者病死率、并发症情况、临床症状、体征及实验室检查恢复正常时间以及治疗前和血液净化72h后APACHEⅡ评分、MODS评分和炎症因子变化。结果CVVH组和SLEDF组在患者病死率（90．9t％与90．00％，x2=0．010，P=0．920）、并发症发生率（18．18％与20．00％，x2=0．023，P=0．881）、临床症状、体征及实验室检查恢复正常时间等方面比较，差异均无统计学意义（P均〉0．05）。SLEDF组治疗72h后APACHEⅡ评分[（12．1±6．1）与（11．9±7．2），t=0．097，P=0．920]、MODS评分[（4．3±1．7）与（4．4±1．8），t=0．185，P=0．850]、C反应蛋白[（161．7±22．9）、（157．6±21．8）mg／L，t=O．594，P=O．550]、肿瘤坏死因子α[（5．8±1．9）、（5．7±1．8）ng／L，t=0．175，P=0．860]、白细胞介素6[（4．1±1．2）、（4．2±1．1）pg／L，t=0．282，P=0．780]和白细胞介素8[（3．3±1．4）、（3．2±1．0）pg／L，t=0．268，P=0．790]和CVVH组治疗72h后比较，差异均无统计学意义；但两组上述各指标治疗72h后均低于治疗前（P均〈0．05）。结论SLEDF和CVVH在清除SAP患者体内炎症因子、缓解病情和改善预后等方面疗效相似。

Objective To evaluate the treatment effect of sustained low-efficiency diafihration（SLEDF） on patients with severe acute pancreatitis（SAP）. Methods Forty-two patients with SAP were randomly divided into continuous veno-venous hemofihration（CVVH） group with 22 patients and SLEDF group with 20 patients. In addition to routine treatment, patients in CVVH and SLEDF were administrated to patients respectively in two groups. Mortality, incidence of complication, clinical symptoms, sign and laboratory examination and recovery time were recorded and measured. The scores of acute physiology and chronic health evaluation （APACHE） II and multiple organ dysfunction syndrome （ MODS ） were performed. The level of C-reactive protein （ CRP ）, tumor necrosis factor-α（ TNF-α）, interleukin （IL）-6 and IL-8 were measured. Results There were no significant differences in terms of the mortality （90. 91% vs. 90. 00% ;X2 = 0. 010, P =0. 920 ）, incidence of complication （ 18. 18% vs. 20. 00% ; X2 = 0. 023, P = 0. 881 ） and recovery time of clinical symptoms, sign and laboratory examination in CVVH group and SLEDF（P 〉 0. 05 ）. There were also no significant differences between CVVH and SLEDF group in terms of scores of APACHE II （ （ 12. 1 ± 6. 1 ） vs. （ 11.9 ±7.2 ） ; t = 0. 097, P = 0. 920）, MODS（（4. 3 ±1.7） vs. （4.4 -±1.8） ;t=0. 185,P =0. 850） ,CRP（（161.7 ±22.9） mg/L vs. （157.6±21.8） mg/L ; t = 0. 594,P = 0. 550） ,TNF-α （ （5.8 ± 1.9 ） ng/L vs. （ 5.7 ± 1.8 ） ng/L; t = 0. 175, P = 0. 860）, IL-6 （（4.1±1.2） pg/L vs. （4.2±1.1） pg/L;t =0.282,P =0.780） and IL-8（（3.3 ±1.4） pg/L vs. （3.2 ± 1. 0） pg/L;t =0. 268,P =0. 790） at 72 h post-treatment. However,the above test indices were decreased at 72 h post-treatment than those at admission（P 〉 0. 05 ）. Conclusion SLEDF and CVVI-I are proved with same treatment effect based on the levels of inflammatory cytokine, alleviating pathogenetic condition and improving prognosis in patients with severe acute pancreatitis.