连续静脉-静脉血液滤过对急性重症胆管炎的治疗作用

Effect of Continuous Venovenous Hemofiltration for Treatment of Acute Cholangitisof Severe Type

目的通过比较目前常用一般治疗方法及联用连续性静脉-静脉血液滤过(CVVH)对重症急性胆管炎的治疗效果。方法随机将2011年12月-2015年3月在新疆兵团第一师医院ICU住院的44例重症胆管炎患者分为两组,对照组24例,给予常规药物治疗加PTCD治疗;受试组20例,给予除对照组治疗以外,另给予CVVH治疗;对入住重症医学科期间两组血管活性药物使用时间、机械通气时间、住ICU时间,治疗前及治疗3 d时肝功能(TBIL、ALT、ALP)、血乳酸、降钙素原(PCT)、WBC进行比较。结果 1治疗3d,除对照组PCT水平与治疗前相比差异无统计学意义外,受试组PCT及两组血乳酸、WBC、TBIL、ALT、ALP值较治疗前明显下降,差异有统计学意义(P<0.05);受试组PCT、血乳酸、WBC、TBIL、ALT、ALP较对照组有更明显的下降,差异有统计学意义。2受试组PCT、TBIL、ALT、ALP下降幅度及治疗3d乳酸清除率大于对照组,两组之间差异有统计学意义(P<0.01)。3受试组使用升压药物时间、机械通气时间、住ICU时间均明显短于对照组,两组间差异有统计学意义(P<0.01)。结论在常规药物及PTCD治疗基础上,加用CVVH治疗,有利于ACST伴发严重脓毒症控制,有利于肝功能改善,可以尽快稳定循环、改善组织灌注及氧合、尽早撤用呼吸机,最终较快较好地稳定病情。

Objective Tocomparetheeffect of continuousvenovenoushemofiltration（ CVVH） with thenormal treatment method for Treatment of acute cholangitis of severe type（ ACST）. Methods 44 cases with ACST were enrolled to the study. These cases were randomly divided intocontrol group（n= 24）and subject group（n= 20）.Percutaneoustranshepatic biliary drainage（PTCD）and regular medication including fluid resuscitation,antibiotics,mechanical ventilation,vasoactive agents and other symptomatic treatments were used in both groups.In subject group, the CVVH was given.The time of vasoactive agents use, mechanical ventilation and ICU stay were counted. TBIL, ALT, ALP, lactate, procalcitonin（PCT）,white blood cells（WBC）？in blood were measured and compared at the time of pre treatment and the3 rd day after treatment during ICU stay in both groups. Results㈠Between the time of pre and the 3rd day of accepted therapy,There was no significant difference in PCT in control group;while the level of PCT in subject group and lactate,WBC,TBIL, ALT,ALPin both groups decreased significantly, therewas statistically significant（ P〈0.05）. Compared control group, the level of PCT,lactate,WBC,TBIL, ALT and ALPin subject group was declined obviously and thedifference were statistically significant（P〈0.05）.②There were more change of PCT,TBIL,ALT,ALP and the lactate clearance in subject group than in control group, there was significant difference between the 2 groups（ P〈0.01）. ③ The time of vasoactive agents use, mechanical ventilation and ICU stay in subject group was significantly shorter than in control group, there was significant difference between the 2 groups（ P 0.01）. Conclusion he therapy of CVVH combined with the regular medication and PTCD can stop the progress of serve sepsis happened in ACST patients,was beneficial for the improvement of liver function and the stabilize of circulation,improvement of tissue perfusion and oxygenation,Ventilator weaning assoon aspossible.Ultimately, thecondition can bestabled better and faster.