重症急性胰腺炎ICU早期CRRT治疗疗效评估

The efficacy evaluation of early CRRT for severe acute pancreatitis in ICU

目的探讨重症监护病房(ICU)早期连续性肾脏替代疗法(CRRT)治疗急性重症胰腺炎的临床效果。方法前瞻性纳入2015年6月至2017年3月期间收治的84例急性重症胰腺炎患者,通过计算机随机编码分为两组:42例行CRRT(观察组),42例行常规治疗(对照组),统计两组患者的疗效、症状改善情况、ICU住院时间及治疗前后血清标志物变化。结果观察组、对照组总有效率分别为92.86%、85.71%,两组疗效对比差异无统计学意义(P>0.05);观察组患者症状缓解时间、生命体征稳定时间、胃肠功能恢复时间、ICU住院时间均少于对照组,差异有统计学意义[(3.16±1.28)d vs(5.21±1.45)d,t=3.518,P=0.017;(2.55±1.36)d vs(4.34±1.51)d,t=2.519,P=0.034;(4.46±1.28)d vs(6.28±1.51)d,t=2.685,P=0.028;(15.06±2.24)d vs(19.34±3.28)d,t=6.983,P=0.009]。两组患者治疗前血淀粉酶(AMS)、IL-6、CRP、TNF-α、PT、FIB差异无统计学意义(均P>0.05),治疗后5 d观察组AMS、IL-6、CRP、TNF-α、PT、FIB的水平均低于对照组,差异有统计学意义[(206.59±19.51)U/L vs(258.12±22.43)U/L,t=11.234,P=0.001;(34.58±6.41)ng/L vs(41.36±8.52)ng/L,t=4.121,P=0.013;(88.24±6.95)ng/L vs(104.33±10.82)ng/L,t=8.109,P=0.002;(178.35±27.43)pg/ml vs(249.28±34.33)pg/ml,t=7.384,P=0.007;(12.48±3.54)s vs(14.56±4.62)s,t=6.473,P=0.011;(3.38±1.55)g/L vs(4.57±2.86)g/L,t=4.108,P=0.041]。两组患者治疗后均痊愈出院,住院期间无严重并发症发生。结论早期CRRT治疗重症急性胰腺炎可较快缓解患者症状,快速降低血清指标,疗效确切。

ObjectiveTo investigate the efficacy evaluation of early continuous renal replacement therapy （CRRT） for severe acute pancreatitis in intensive care unit （ICU）. MethodsProspective study was performed for 84 patients with severe acute pancreatitis admitted to the Xinjiang Provincial People＇s Hospital from June 2015 to March 2017. Those patients were divided into two groups by computer random coding： 42 cases treated with CRRT （observation group）, and 42 cases received routine treatment （control group）. Statistically analysis was carried out between two groups regarding curative effect, symptom improvement, ICU hospitalization time, and serum markers before and after treatment. ResultsThe total effective rate was 92.86 % in the observation group, and 85.71% in the control group, without significant difference between two groups （F=0.516, P=0.632）. Patients with symptoms, vital signs stable time, gastrointestinal function recovery time, and hospitalization time of ICU were significantly lower in the observation group than the control group [（3.16±1.28）days： （5.21±1.45）days, t=3.518, P=0.017, （2.55±1.36）days： （4.34±1.51）days, t=2.519, P=0.034, （4.46±1.28）days： （6.28±1.51）days, t=2.685, P=0.028, （15.06±2.24）days： （19.34±3.28） days, t=6.983, P=0.009]. There is no significant differences in amylase （AMS）, interleukin （IL）-6, C-reaction protein （CRP）, tumor necrosis factor （TNF）-α, prothrombin time （PT） and fibrinogen （FIB） before treatment between two groups （P〉0.05）. The observation group were significantly lower than the control group in AMS, IL-6, CRP, TNF-α, PT, and FIB levels after treatment [（206.59±19.51）U/L： （258.12±22.43）U/L, t=11.234, P=0.001, （34.58±6.41）ng/L： （41.36±8.52）ng/L, t=4.121, P=0.013, （88.24±6.95）ng/L： （104.33±10.82） ng/L, t=8.109, P=0.002, （178.35±27.43）pg/ml： （249.28±34.33）pg/ml, t=7.384, P=0.007, （12.48±3.54）s： （14.56±4.62）s, t=6.473, P=0.011, （3.38±1.55）g/L： （4.57±2.86）g/L, t=4.108, P=0.041]. Two groups of patients after treatment were cured, and no serious complications occurred during hospitalization. ConclusionsFor patients with severe acute pancreatitis, the overall effective rate of CRRT in ICU was high, the clinical symptoms relieved quickly, the level of serum indicators improved effectively.