连续性肾替代治疗重症胰腺炎的疗效观察

Observation of the efficacy of CRRT in the treatment of severe pancreatitis

目的 探讨连续性肾替代（CRRT）治疗重症胰腺炎患者的临床疗效.方法 重症胰腺炎患者120例,按照治疗方法不同分为两组,各60例,两组均行所有患者均给予基础治疗,观察组在此基础上给予CRRT治疗;观察两组患者治疗72h后血乳酸水平（Lac）、APACHEⅡ评分、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）变化、C反应蛋白（CRP）水平变化.观察治疗前、治疗后72 h的肿瘤细胞坏死因子（TNF-α）、白细胞介素6（IL-6）、白细胞介素1β（IL-1β）的水平变化情况.观察两组治疗28 d的患者病死率及住院时间.结果 两组治疗后Lac[对照组（3.32±0.85）mmol/L,观察组（2.55±0.65）mmol/L]、APACHEⅡ评分[对照组（13.30±2.80）分,观察组（12.01±2.60）分]、CRP[对照组（24.30±2.80）mg/L,观察组（12.33±1.60）mg/L]较治疗前降低[治疗前Lac：对照组（4.85±1.05）mmol/L,观察组（4.90±1.02）mmol/L;APACHEⅡ评分：对照组（16.62±2.95）分,观察组（16.90±3.01）分,CRP：对照组（40.32±3.10）mg/L,观察组（40.40±3.51）mg/L,对照组：tLac=1.67、P=0.004,tAPACHEⅡ=6.32、P=0.000,tCRP=29.71、P=0.000;观察组：tLac=15.05、P=0.005,tAPACHEⅡ=9.52、P=0.000,tCRP=56.36、P=0.000]、PaO2[对照组（75.30±4.80）mmHg,观察组（84.31±4.60）mmHg]、PaO2/FiO2[对照组（225.30±14.83）mmHg,观察组（256.31±14.65）mmHg]较治疗前[PaO2：对照组（60.32±4.15）mmHg,观察组（60.40±4.01）mmHg;PaO2/FiO2：对照组130.39±11.15,观察组130.90±11.01]（对照组：tPaO2=18.29、P=0.000,tPaO2/FiO2=39.62、P=0.000;观察组：tPaO2=30.35、P=0.000,tPaO2/FiO2=53.01、P=0.000]升高,观察组各指标改善程度均高于对照组（tLac=5.574、P=0.000,tAPACHEⅡ=2.615、P=0.005,tPaO2=3.646、P=0.000,tPaO2/FiO2=11.523、P=0.000,tCRP=28.751、P=0.000）;两组治疗后TNF-α、IL-6、IL-1β[对照组：IL-1β（70.32±6.85）ng/mL、IL-6（103.30±8.80）ng/mL、TNF-α（89.30±8.80）ng/mL;观察组：IL-1β（48.55±6.62）ng/mL、IL-6（92.01±8.60）ng/mL、TNF-α（57.31±7.60）ng/mL]均较治疗前[对照组：IL-1β（82.85±7.05）ng/mL、IL-6（173.62±9.95）ng/mL、TNF-α（105.32±9.15）ng/mL,观察组：IL-1β（83.90±7.32）ng/mL、IL-6（175.90±10.01）ng/mL、TNF-α（106.40±9.01）ng/mL]得到改善（对照组：tIL-1β=9.66、P=0.000,tIL-6=41.01、P=0.000,tTNF-α=9.77、P=0.000;观察组：tIL-1β=27.74、P=0.000,tIL-6=49.23、P=0.000,tTNF-α=32.26、P=0.000],但观察组改善程度相比对照组更为显著（tIL-1β=17.702、P=0.000,tIL-6=7.107、P=0.000,tTNF-α=21.311、P=0.000）;观察组病死率18.33%及住院时间（10.97±2.92）d,明显低于对照组的36.67%、（13.63±3.26）d（χ^2=5.058,P=0.025;t=4.708,P=0.000）.结论 使用CRRT治疗重症胰腺炎可改善患者生命体征,降低炎症指标,改善血清中炎症因子及乳酸水平,降低患者病死率及住院时间.

Objective To investigate the clinical efficacy of CRRT in the treatment of severe pancreatitis.Methods 120 patients with severe pancreatitis were divided into two groups according to the treatment.All the patients were given basic treatment in all groups.The Pa arterial oxygen pressure （PaO2）,oxygenation index （PaO2/FiO2）,and C-reactive protein （CRP） in the two groups after 72 hours of treatment were observed.The levels of blood lactate （Lac）,APACHEII,tumor necrosis factor α（TNF-α）,interleukin-6 （IL-6） and interleukin-1β （IL-1β） were measured before and after treatment 72 hours.A comparison of mortality and hospitalization time was observed in 28 days of treatment.Results After treatment,Lac [the control group （3.32±0.85）mmol/L,the observation group （2.55±0.65）mmol/L],APACHEII score [the control group （13.30±2.80）points,the observation group （12.01±2.60）points],CRP [the control group （24.30±2.80）mg/L,the observation group （12.33±1.60）mg/L] were significantly lower than before treatment [Lac：the control group （4.85±1.05）mmol/L,the observation group （4.90±1.02）mmol/L;APACHEII score：the control group （16.62±2.95）points,the observation group （16.90±3.01）points;CRP：the control group （40.32±3.10）mg/L,the observation group （40.40±3.51）mg/L;the control group：tLac=1.67,P=0.004,tAPACHEII=6.32,P=0.000,tCRP=29.71,P=0.000;the observation group：tLac=15.05,P=0.005,tAPACHEII=9.52,P=0.000,tCRP=56.36,P=0.000].PaO2 [the control group （75.30±4.80）mmHg,the observation group （84.31±4.60）mmHg], PaO2/FiO2 [the control group （225.30±14.83）mmHg,the observation group （256.31±14.65）mmHg] were significantly higher than before treatment [PaO2：the control group （60.32±4.15）mmHg,the observation group （60.40±4.01）mmHg;PaO2/FiO2：the control group （130.39±11.15）mmHg,the observation group （130.90±11.01）mmHg;the control group：tPaO2=18.29,P=0.000,tPaO2/FiO2=39.62,P=0.000;the observation group：tPaO2=30.35,P=0.000,tPaO2/FiO2=53.01,P=0.000].Those in the observation group were significantly improved than the control group （tLac=5.574,P=0.00,tAPACHEII score=2.615,P=0.005,tPaO2=3.646,P=0.0002,tPaO2/FiO2=11.523,P=0.00,tCRP=28.751,P=0.000）.After treatment,the TNF-α,IL-6 and IL-1β levels in the two groups [the control group：IL-1β （70.32±6.85）ng/mL,IL-6 （103.30±8.80）ng/mL,TNF-α （89.30±8.80） ng/mL;the observation group：IL-1β（48.55±6.62）ng/mL,IL-6（92.01±8.60）ng/mL,TNF-α（57.31±7.60）ng/mL] were significantly improved than before treatment [the control group：IL-1β（82.85±7.05）ng/mL,IL-6（173.62±9.95）ng/mL,TNF-α （105.32±9.15）ng/mL;the observation group：IL-1β（83.90±7.32）ng/mL,IL-6 （175.90±10.01）ng/mL,TNF-α （106.40±9.01）ng/mL;the control group：tIL-1β=9.66,P=0.000,tIL-6=41.01,P=0.000,tTNF-α=9.77,P=0.000;the observation group：tIL-1β=27.74,P=0.000,tIL-6=49.23,P=0.000,tTNF-α=32.26,P=0.000].And those of the observation group improved more significantly than the control group （tIL-1β=17.702,P=0.00,tIL-6=7.107,P=0.00,tTNF-α=21.311,P=0.000）.The mortality rate and hospitalization time of the observation group were 18.33% and （10.97±2.92）days,which were significantly lower than those of the control group [36.67%,（13.63±3.26）days;χ^2=5.058,P=0.025;t=4.708,P=0.000）.Conclusion The use of CRRT in the treatment of severe pancreatitis can improve the vital signs,reduce the inflammation index,improve the serum levels of inflammatory factors and lactic acid,reduce the mortality and hospital stay.