早期高容量血液滤过治疗重症急性胰腺炎伴急性呼吸窘迫综合征疗效观察

Effects of early high - volume hemofiltration on severe acute pancreatitis patients with respiratory distress syndrome

目的评价早期高容量血液滤过（HVHF）治疗重症急性胰腺炎（SAP）伴急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法将入选的SAP伴有ARDS的30例患者随机分为治疗组和对照组，每组15例。以机械通气（血液净化治疗开始）为起始点，分别于0、12、24、36、48、60、72h采集患者以下指标：肿瘤坏死因子“（TNF-α）、白细胞介素-10（IL-10）的浓度；呼吸频率、氧合指数、动脉血二氧化碳分压；急性生理与慢性健康评分（a—cute physiology and chronic health evaluationⅡ，APACHE Ⅱ）；并记录2组患者住院期间机械通气时间、ICU住院时间、总住院时间、住院病死率及28天病死率。结果①血液净化治疗后，治疗组患者IL-10、TNF-α浓度下降，与治疗前相比差异有统计学意义（P〈0．05）；且在24h及以后各时点IL-10、TNF-α浓度较对照组同一时间点下降（P〈0．05）。②呼吸系统指标：治疗后2组患者氧合指数逐渐升高，治疗组患者在24h后各时间点与对照组相比差异有统计学意义（P〈0．05）。2组患者的呼吸频率较治疗前均下降，治疗组下降显著，在60、72h2个时点与对照组相比差异有统计学意义（P〈0．05）。治疗组平均机械通气时间少于对照组（P〈0．05）。⑧APACHEⅡ评分：治疗后2组患者的APACHEⅡ评分均逐渐下降，治疗组改善明显，在12h及以后各时间点APACHEⅡ评分低于对照组（P〈0．05）。④住院时间及病死率：治疗组ICU住院时间、总住院时间均少于对照组（P〈0．05）。治疗组患者住院病死率及28天病死率较对照组下降，但差异无统计学意义（P〉0．05）。结论早期高容量血液滤过可以清除SAP伴ARDS患者循环中炎症介质，改善患者的呼吸功能，减轻患者病情，减少ICU及总住院时间。

Objective To assess the efficacy of early high - volume hemofiltration （HVHF） on severe acute pancreatitis （SAP） patients with acute respiratory distress syndrome （ARDS）. Methods A total of 30 SAP patients with ARDS were enrolled into the study. The patients were randomly divided into a treatment group and a control group （ n = 15 ）. With mechanical ventilation as the starting point, the levels of tumor necrosis factor ct （ TNF - α） and interleukin - 10 （IL- 10）, and respiratory rate （RR） , oxygenation index, arterial partial pressure of carbon dioxide, acute physiolo- gy and chronic health evaluation II （ APACHE II ） scores were measured on 0, 12, 24, 36, 48, 60 and 72 h. The time of mechanical ventilation, ICU and hospitalization stay, mortality in hospital and within 28 days were also recorded. Results After hemofiltration, the treatment group produced decreased levels of TNF - α and IL - 10 compared with the levels before treatment （P 〈0.05） and those in the control group on 24, 36, 48, 60 and 72 h （P 〈 0.05 ）. After treat- ment, oxygenation index was increased in both groups compared with the levels before treatment, where the treatment group showed remarkably a higher oxygenation index than the control on 24, 36, 48, 60 and 72 h （ P 〈 0.05 ）. After treatment, RR was decreased in both groups compared with the levels before treatment, where the treatment group showed remarkably lower RR than the control on 60 and 72 h （ P 〈 0.05 ）. The time of mechanical ventilation was markedly shortened in the treatment group compared with the control （ P 〈 0.05 ）. After treatment, APACHE Ⅱ was decreased in both groups compared with the levels before treatment, where the treatment group showed remarkably lower APACHE Ⅱ than the control on 12, 24, 36, 48, 60 and 72 h （ P 〈 0. 05 ）. Furthermore, the treatment group required shorter ICU and hospitalization stay than the control （P 〈 0. 05）. However, no statistical difference was found as to mortality in hospital and within 28 days between the two groups （P 〉 0.05）. Conclusions Early HVHF can clear the inflammatory factors within the circulation of SAP patients with ARDS, improve the respiratory function, relieve the syndromes, and reduce ICU and hospitalization stay.