急性胰腺炎合并Ⅱ期急性肾损伤时行短时静-静脉血液滤过治疗的临床意义

Short Venovenous Hemofiltration Treatment on Acute Pancreatitis Patients with Ⅱ Stage Acute Kidney Injury

目的:回顾性分析短时静-静脉血液滤过(SVVH)治疗急性胰腺炎(AP)合并Ⅱ期急性肾损伤(AKI)的临床意义。方法:回顾性分析AP合并Ⅱ期AKI患者51例,将在Ⅱ期AKI时开始行SVVH治疗的患者设为SVVH组24例,在Ⅱ期AKI时只接受常规治疗的患者设为对照组27例,血液净化方式为SVVH每日12 h,比较两组患者治疗1周后BUN、Cr、胱抑素C、降钙素原(PCT)、C反应蛋白(CRP)、白细胞水平变化、心率、呼吸、平均动脉压、尿量等基本生命体征的变化,及APACHEⅡ评分和AKI分期的变化。结果:两组患者在治疗1周后,SVVH组患者AKI分期总体低于对照组,进展为Ⅲ期AKI的患者比例为20.8%,小于对照组的40.7%(P<0.01)。SVVH组患者血BUN平均值为(11.43±3.25)mmol/L,低于对照组的(17.31±9.52)mmol/L;SCr平均值为(179.63±152.01)μmol/L,低于对照组的(415.31±253.43)μmol/L;胱抑素C平均值为(1.98±0.97)mg/L,低于对照组的(3.19±1.24)mg/L;尿量平均值为(0.66±0.39)m L·kg-1·h-1,大于对照组的(0.43±0.21)m L·kg-1·h-1。SVVH组患者APACHEⅡ评分平均值为(13.77±7.19),小于对照组的(15.68±6.41)(P<0.05)。SVVH组患者PCT平均值为(2.48±1.52)ng/m L,低于对照组的(7.01±4.51)ng/m L;CRP平均值为(99.67±68.07)mg/L,低于对照组的(120.39±98.43)mg/L;血白细胞平均值为(9.56±4.22)×109/L,低于对照组的(12.56±8.34)×109/L。结论:在AP患者合并Ⅱ期AKI时行SVVH治疗,对保护肾功能具有积极作用。1.天津中医药大学研究生院(天津300193)2.天津市南开医院肾内科(天津300100)3.天津市天津医院重症医学科(天津300211)

Objective To study the clinical significance of short venovenous hemofiltration therapy onacute pancreatitis with Ⅱstage acute kidney injury.MethodsFifty one patients with acute pancreatitis com-bined Ⅱ stage acute kidney injury were analysed retrospectively,24 patients were selected as short venovenoushemofiltration treatment（SVVH） group who were treated with conventional methods and short venovenous hemo-filtration,12 hours per day. the other 27 patients only took conservative treatment were chosen as control group.The blood ureanitrogen（BUN）,Serum creatinine（Cr）,procallcitonin（PCT）,Cystatin C（Cys C）,C-reactive protein（CRP）,Leucocyte level,heart rate（HR）,respiratory rate（RR）,mean arterial pressure（MAP）,urine volume,APACHEⅡ scores and AKI stage of the two groups were taken for comparison and observation after a week ofthe treatment.ResultsAfter one week of treatment,the Ⅲ stage AKI patients proportion of the SVVH groupwas 20.8%,lower than that of control group 40.7%（P〈0.05）. In the SVVH group the average value of BUNwas（11.43＋3.25） mmol/L, lower than that of control group（17.31±9.52） mmol/L（P〈0.05）; the average value ofSCr was（179.63±152.01） μmol/L, lower than that of control group（415.31±253.43） μmol/L（P〈0.05）; the aver-age value of Cystatin C was（1.98±0.97） mg/L, lower than that of control group（3.19±1.24） mg/L（P〈0.05）; theaverage amount of urine was（0.66±0.39） mL·kg^-1·h^-1, higher than that of control group（0.43＋0.21） mL·kg^-1·h^-1（P〈0.05）; the average value of APACHE II scores was 13.77±7.19, less than that of control group 15.68＋6.41（P〈0.05）; the average value of PCT was（2.48±1.52） ng/mL, lower than that of control group（7.01±4.51） ng/mL（P〈0.05）; the average value of CRP was（99.67±68.07） mg/L, lower than that of control group（120.39±98.43）mg/L（P〈0.05）; the average value of CRP was（99.67±68.07） mg/L, lower than that of control group（120.39±98.43） mg/L（P〈0.05）; the average number of white cells was（9.56 ± 4.22） × 10^9/L, lower than that of controlgroup（12.56±8.34）×10^9/L.ConclusionIn AP with Ⅱstage AKI, SVVH treatment can protect the renal func-tion of the patient.