早期持续血液滤过联合芒硝外敷治疗重症急性胰腺炎的临床观察

Clinical effect of early continuous hemofiltration combined with mirabilite external application in the treatment of severe acute pancreatitis

目的探讨早期持续血液滤过联合芒硝外敷治疗重症急性胰腺炎的临床疗效。方法选取2015年6月-2017年12月期间本院收治的68例重症急性胰腺炎患者。随机分为对照组和观察组,各34例。所有患者入院后均给予相应常规内科综合治疗,在此基础上,对照组用芒硝外敷治疗,观察组给予早期持续血液滤过联合芒硝外敷治疗;比较两组患者治疗前后生命体征、APACHEⅡ评分、血清生化指标,治疗后腹痛症状缓解时间、肠鸣音恢复时间、首次排便时间及住院时间等情况。结果两组患者治疗前后生命体征、APACHEⅡ评分、腹腔内压、血清生化指标、炎症反应指标等比较无显著差异(P>0.05),治疗后均明显改善(P<0.05);观察组治疗后体温、心率、呼吸频率、平均动脉压、APACHEⅡ评分、腹腔内压、AMY、ALT、SCr、BUN、CRP、PaO_2/FiO_2及白细胞计数等指标,改善效果明显优于对照组(P<0.05);观察组治疗后腹痛缓解时间、肠鸣音恢复时间、首次排便时间及住院时间均显著少于对照组(P<0.05)。结论早期持续血液过滤联合芒硝外敷法能有效缓解患者临床症状及体征、改善患者器官功能、提高临床疗效,是临床治疗重症急性胰腺炎的有效措施。

Objective To explore the clinical effect of early continuous hemofiltration combined with Glauber＇s salt application in the treatment of severe acute pancreatitis. Methods 68 patients with severe acute pancreatitis admitted in our hospital during the period of June 2015-2017 November were selected,Randomly divided into the control group and the observation group,34 cases in each group. All patients were treated with routine treatment after admission,on the basis of this. the control group treated with the external application of mirabilite,The observation group was given early continuous hemofiltration combined with the external application of mirabilite. The life signs,APACHE II score,serum biochemical indexes,inflammatory reaction indexes,abdominal pain relief time,bowel sounds recovery time,first defecation time and hospitalization time were compared before and after treatment in the two groups. Results There was no significant difference in vital signs,APACHE II score,intra-abdominal pressure,serum biochemical indexes and inflammatory reaction indexes between the two groups before treatment（P〈0.05）,which was significantly improved after treatment（P〈0.05）. The observation group after treatment of body temperature,heart rate,respiratory rate,mean arterial pressure,intra-abdominal pressure,APACHEII score,AMY,ALT,SCr,BUN,CRP,PaO2/FiO2 and WBC were improved significantly better than the control group（P〈0.05）;the observation group after the treatment of abdominal pain,bowel sounds recovery,first defecation and hospitalization time were significantly less than control group（P〈0.05）. Conclusion Early continuous blood filtration combined with external application of mirabilite relieves the clinical symptoms and signs,improves organ function and improves the clinical efficacy. It is an effective measure for clinical treatment of severe acute pancreatitis.