连续性高容量血液滤过在重症急性胰腺炎中的应用

Application of Continuous High Volume Hemofiltration on Severe Acute Pancreatitis

目的:探讨重症急性胰腺炎(severe acute pancreatitis,SAP)患者辅助应用连续性高容量血液滤过(continuous high volume hemofiltration,CHVHF)的临床效果。方法:选取南京军区福州总医院2009年02月~2016年02月间收治的60例SAP病例资料进行分析,20例采用常规治疗+CHVHF辅助治疗,为CHVHF组;20例采用常规治疗+连续性静脉-静脉血液滤过(continuous venous-venous hemofiltration,CVVH)辅助治疗,为CVVH组,另随机选取同期收治的20例仅采用常规治疗方法的病例,作为常规对照组,观察3组临床疗效和转归。结果:各组患者治疗前一般情况及各项检查指标均无明显差异(P>0.05);治疗后24 h、72 h、5 d不同时间点,CHVHF组与CVVH组的各项生命体征及生化指标改善均优于常规治疗组,且CHVHF组指标改善优于CVVH组,包括:体温降低(F=7.841,P<0.001)、心率减慢(F=9.318,P<0.001)、平均动脉压升高(F=5.671,P<0.001)、APACHEⅡ评分降低(F=7.087,P<0.001);血钙升高(F=7.398,P<0.001)、血肌酐降低(F=3.365,P=0.032)、尿素氮降低(F=6.157,P<0.001)、血淀粉酶降低(F=5.507,P<0.001)、C反应蛋白降低(F=6.168,P<0.001)。28 d病死率比较可见CHVHF组及CVVH组均低于对照组(χ2=7.121,P=0.028),但CHVHF组与CVVH组之间28 d病死率差异无统计学意义(P>0.05)。结论:连续性血液净化治疗是辅助治疗SAP患者的有效手段之一,可能改善患者的预后,而CHVHF模式较CVVH模式可更有效清除炎症介质、稳定患者生命体征,但CHVHF模式是否能更进一步降低病死率尚需要更多研究加以明确。

Objective： To investigate the treatment effect of continuous high volume hemofiltration（CHVHF） on severe acute pancreatitis（SAP） patients. Methods： A total of 60 patients with SAP in Fuzhou General Hospital of Nanjing Military Command during the period from Feb 2009 to Feb 2016 were enrolled in this study. They were divided into CHVHF group（n = 20）,continuous venous-venous hemofiltration（CVVH） group（n = 20） and control group（n = 20）. Patients in CHVHF group were treated with comprehensive measures plus CHVHF,Patients in CVVH group were treated with comprehensive measures plus CVVH and patients in control group were only treated with comprehensive measures. The treatment effect and prognosis among three groups were compared.Results： Before treatment,there were no significant differences in vital signs and biochemical data among three groups（P〈0. 05）.The treatment effects in different time periods（24 h,72 h,5 d） were better in CHVHF group than in CVVH group and control group： temperature declined（F = 7. 841,P〈0. 001）,heart rate declined（F = 9. 318,P〈0. 001）,mean arterial blood pressure increased（F = 5. 671,P〈0. 001）,scores of APACHE II declined（F = 7. 087,P〈0. 001）,serum calcium increased（F = 7. 398,P〈0. 001）,serum creatinine declined（F = 3. 365,P = 0. 032）,urea declined（F = 6. 157,P〈0. 001）,serum amylase declined（F =5. 507,P〈0. 001）,and the C reactive protein declined also（F = 6. 168,P〈0. 001）. 28 d mortality was lower in CHVHF group and CVVH group than in control group（χ^2= 7. 121,P = 0. 028）,however,28 d mortality was no significant difference between CHVHF group and CVVH group（P〈0. 05）. Conclusion： Continuous renal replacement therapy is one of effective approach treatment in SAP patients. It may improve the prognosis of SAP. CHVHF model is more effective than CVVH model in clearing inflammatory mediators and stabilizing vital signs of patients. However,more studies are needed to clarify whether CHVHF model can further reduce the mortality.