50％前后稀释联合方式连续性血液净化治疗重症急性胰腺炎的效果评价

Continuing blood purification via 50% pre-and post-dilution for patients with serious acute pancreatitis

目的 探讨不同前后稀释比例输入置换液连续性血液净化治疗重症急性胰腺炎的临床效果以及对滤器寿命的影响.方法 将40例采用连续性血液净化治疗的重症急性胰腺炎患者根据不同置换液稀释法随机分为两组：采用100％前稀释法进行治疗的100％前稀释组20例,采用50％前稀释＋50％后稀释法进行治疗的50％前后稀释联合组20例,在治疗中进行持续心电及无创性血流动力学监测,治疗前及治疗中第4、8小时及治疗结束前采血检测肌酐、C-反应蛋白的变化,每4小时检测腹内压的变化,统计治疗12h、24 h所需置换液量和两组滤器寿命.结果 50％前后稀释联合组的最大滤前压、每次治疗所需置换液量及Cr、CRP指标均低于100％前稀释组,而滤器的使用寿命长于100％前稀释组,两组比较,差异均有统计学意义（P＜0.05）.结论 采用50％前后稀释联合方式进行连续性血液净化治疗能更好地清除重症急性胰腺炎患者血液中的炎症介质,保持生命体征稳定,而且能够减少滤器的更换、减轻护理工作量,并为患者节约治疗费用,值得临床推广应用.

Objective To explore the clinical effectiveness of continuing blood purification via 50% pre-and post-dilution for patients with serious acute pancreatitis and to assess its impact on the life span of filters.Methods 40 patients with serious acute pancreatitis who need to be treated by continuing blood purification were randomly divided into a 100% pre-dilution group,treated with 100% pre-dilution method,and a 50% pre-and post-dilution group,treated with 50% pre-and post-dilution method.During the treatment,the electrocardiogram and noninvasive blood flow dynamics were continuously monitored.Before and hour 4 and 8 of the treatment,the blood was collected to examine the changes of creatinine （Cr） and C-reactive protein （CRP）;the pressure within abdominal cavity was measured every 4 hours;the substitution fluid volumes needed within 12 and 24 hours and the life span of filters of both groups were calculated.Results The highest pressure before filtering was lower,the substitution volume needed by each treatment was less,the levels of Cr And CRP were lower,and the life span of filters was longer in the 50% pre-and post-dilution group than in the 100% pre-dilution group,with statistical differences （P〈0.05）.Conclusions Continuing blood purification via 50% pre-and post-dilution for patients with serious acute pancreatitis can effectively eliminate the inflammation medium in the blood of the patients,keep life indicators stable,and reduce the times of changing filters,nursing work,the patients＇ treatment cost.It is worth being clinically generalized.