腹膜透析治疗急性重症胰腺炎临床疗效观察

Clinical observation of peritoneal dialysis in treating severe pancreatitis

目的观察腹膜透析治疗急性重症胰腺炎(severe acute pancreatitis,SAP)的疗效。方法分析我院2004年1月-2013年12月收治的SAP患者36例,腹膜透析组(治疗组)21例患者给予腹膜透析治疗,非透析组(对照组)15例给予药物治疗或外科手术治疗等,比较两组腹部症状缓解时间,呼吸机脱机时间,血、尿淀粉酶正常时间,Balthazar CT积分,APACHEII积分,外周血中IL-6、PCT、CRP治疗后各时相水平,以及住院费用、治愈率、死亡率、并发症发生率。结果腹膜透析组的腹部症状缓解时间(16.08±4.32天比30.16±14.33天,t=4.261,P=0.000)、呼吸机脱机时间(8.50±2.65天比18.66±6.56天,t=6.429,P=0.000)、血淀粉酶正常时间(13.5±5.93天比25.68±11.36天,t=4.193,P=0.0002)、尿淀粉酶正常时间(13.92±6.96天比28.77±12.67天,t=4.516,P=0.0001)均短于对照组,治疗组Balthazar CT积分在治疗7、14天(5.33±0.67比7.95±0.53,t=12.577,P=0.000和2.08±0.16比7.19±0.32,t=63.188,P=0.000)均低于对照组,APACHEII积分在治疗后1、3、5、7天(8.98±2.95比13.05±3.56,t=3.744 P=0.000;7.06±1.84比12.44±3.06,t=6.581,P=0.000;5.09±1.06比10.98±2.73,t=9.021 P=0.0001;3.16±0.74比9.18±1.96,t=12.9054,P=0.000)均低于对照组,治疗组治疗1、3、7天后IL-6(122.02±89.86ng/L比286.47±238.62ng/L,t=2.89,P=0.006;109.86±78.05ng/L比254.83±210.26ng/L,t=2.905,P=0.0064;44.24±18.43ng/L比186.54±145.27ng/L,t=4.464,P=0.0001)、PCT(11.00±6.22ng/L比18.86±12.19ng/L,t=2.538,P=0.016;5.56±3.12ng/L比15.89±9.88ng/L,t=4.509,P=0.000;1.65±0.93ng/L比10.39±5.77ng/L,t=6.856,P=0.000)、CRP(96.39±44.13 ng/L比120.14±44.53 ng/L,t=2.068,P=0.022;82.14±38.98ng/L比108.82±41.71 ng/L,t=2.626,P=0.037;46.90±22.24 ng/L比89.45±40.58 ng/L,t=4.043,P=0.000)明显低于对照组,住院时间(33.42±12.27天比58.16±14.38天,t=5.553,P=0.000)、住院费用(13.71±4.93万元比28.54±15.26万元,t=4.1791,P=0.000)明显低于对照组,并发症发生率(14.29%比40.00%,χ2=6.722,P=0.024)、死亡率(0比46.67%,χ2=6.030,P=0.030)显著低于非透析组。结论腹膜透析治疗急性重症胰腺炎疗效明显,治愈率高,有较高的临床应用价值。

Objectives To evaluate the efficacy of peritoneal dialysis （PD） in the treatment of severe acute pancreatitis （SAP）. Methods Thirty-six SAP patients treated in our hospital from January 2004 to Decem- ber 2013 were randomly divided into two groups, PD group （n=21） in which patients were treated with PD, and non-PD group （control group, n=15） in which patients were treated with drugs or surgery. The relief time of abdominal pain and abdominal distension, the time of respiration without mechanical ventilation, the recov- ery time of serum amylase and urine amylase levels, scores of Balthazar CT and APACHE II, changes of in- flammatory cytokines including IL-6, PCT and CRP after treatment, length and expense of hospitalization, and recovery rate were compared between the 2 groups. Results In PD group, the relief time of abdominal pain and abdominal distension, the time of independent respiration without mechanical ventilation, and the re- covery time of serum amylase and urine amylase were significantly lower than those in control group 06.08± 4.32 days vs. 30.16±14.33 days, t=4.261, P=0.000 for the relief time of abdominal pain and abdominal disten- sion; 8.50±2.65 days vs. 18.66±6.56 days, t=-6.429, P=0.000, for the time of independent respiration without mechanical ventilation; 13.5±5.93 days vs. 25.68±11.36 days, t=4.193, P=0.000, for serum amylase; 13.92± 6.96 days vs. 28.77± 12.67 days, t=4.516, P=0.0001, for urine amylase）; Balthazar CT scores after the treat-ment for 7 and 14 days were significantly lower than those in control group （5.33±0.67 vs. 7.95±0.53, t= 12.577, P= 0.000, after treatment for 7 days; 2.08±0.16 vs. 7.19±0.32, t=63.188, P=0.000, after the treatment for 14 days）; APACHE II scores after the treatment for 1, 3, 5, and 7 days were also significantly lower than those in control group （8.98±2.95 vs. 13.05±3.56, t=3.744, P= 0.000, after the treatment for one day; 7.06± 1.84 vs. 12.44±3.06, t=6.5813, P= 0.0001, after the treatment for 3 days; 5.09±1.06 vs. 10.98±.73, t=- 9.021, P= 0.000, after the treatment for 5 days; 3.16±0.74 vs. 9.18±1.96, t=12.905, P= 0.000, after the treatment for 7 days）; Levels of IL-6, PCT, and CRP after the treatment for 1, 3 and 7 days were significantly lower than those in control group （122.02±89.86 ng/L vs. 286.47±238.62 ng/L, t=2.897, P=0.006, for IL-6 after the treat- ment for one day; 109.86±8.05 ng/L vs. 254.83±210.26 ng/L, t=-2.905, P=0.006, for IL-6 after 3 days; 44.24± 18.43 ng/L vs. 186.54±45.27 ng/L, t=-4.464, P=- 0.000, for IL-6 after 7 days; 11.00±.22 ng/L vs. 18.86±12.19ng/L, t=-2.538, P=0.016, for PCT after the treatment for one day; 5.56±.12 ng/L vs. 15.89±9.88 ng/L, t= 4.509, P=0.000, for PCT after the treatment for 3 days; 1.65±.93 ng/Lvs. 10.39±.77 rig/L, t=6.856, P= 0.000, for PCT after the treatment for 7 days; 96.39-4-44.13 ng/L vs. 120.14±4.53 ng/L, t=2.068, P=0.022, for CRP after the treatment for one day; 82.14±8.98 ng/L vs. 108.82±1.71 ng/L, t=-2.626, P：0.037, for CRP af- ter the treatment for 3 days; 46.90±22.24 ng/L vs. 89.45±0.58 ng/L, t=4.043, P= 0.000, for CRP after the treatment for 7 days）; the length and expenses of hospitalization were significantly less than those in the con- trol group （33.42±2.27 days vs. 58.16±4.38 days, t=5.553, P=0.000, for hospitalization days; 13.71±4.93× 10 ^4 yuan vs. 28.54±15.26± 104 yuan, t=4.179, P=0.000, for expenses during hospitalization）; mortality and complication rates were significantly lower than those in control group （14.29% vs. 40.00%, 2;=6.722, P= 0.024, for mortality rate; 0 vs. 46.67%, 2;=6.03, P=0.030, for complication rate）. Conclusion PD was proven to be effective and valuable in the treatment of SAP. PD lowered the mortality and complication rate as well as the time and expenses of hospitalization, and importantly, increased the cure rate.