阶梯式引流联合恒温灌洗对重症急性胰腺炎并发坏死感染患者的疗效分析

A step-up drainage combined with thermostatic lavage in the management of infected pancreatic necrosis

目的探讨阶梯式引流联合恒温灌洗对重症急性胰腺炎并发坏死感染的安全性和有效性。方法自2014年1月至2017年7月,前瞻性收集本院收治的坏死感染性胰腺炎100例,将患者随机(随机数方法)分为观察组和对照组,每组各50例。两组患者均给予序贯性穿刺置管阶梯式引流,观察组给予恒温灌洗(30~35°C),对照组在室温下行腹腔灌洗。观察两组患者的临床预后。结果与对照组比较,观察组新发肾功能损伤率显著降低(16.00%vs 34.00%,P=0.038);新发胃肠功能损伤率显著降低(12.00%vs 28.00%,P=0.046);机械通气时间显著降低[(14.82±7.78)d vs(18.64±8.12)d,P=0.018];持续血液滤过时间显著降低[(12.98±6.20)d vs(18.56±10.92)d,P=0.002];住院时间显著降低[(43.28±10.72)d vs(50.82±12.74)d,P=0.002]。两组患者入院时和穿刺灌洗引流时APACHEⅡ评分均无统计学意义[(9.88±2.40)vs(9.46±2.35),P=0.378]和[(10.30±3.07)vs(0.54±2.96),P=0.692]。穿刺灌洗引流后7 d和14 d时观察组APACHEⅡ评分显著低于对照组[(9.32±2.49)vs(10.56±2.80),P=0.021]和(6.20±2.54)vs(8.42±2.48),P<0.01)]。结论阶梯式引流联合恒温灌洗可降低重症急性胰腺炎并发坏死感染患者新发肾功能衰竭和胃肠功能损伤,改善患者临床预后。

Objective To investigate the safety and efficacy of a step-up drainage combined with thermostatic lavage in the management of severe acute pancreatitis complicated with infected pancreatic necrosis.Methods From January 2014 to July 2017,100 cases of severe acute pancreatitis complicated with infected pancreatic necrosis admitted to our hospital were prospectively collected.All patients were randomly(random number)assigned into the observation group and control group with 50 cases in each group.The patients in both groups were given a step-up drainage.Moreover,patients in the observation group received lavage under constant temperature(30-35°C)while the patients in the control group were at room temperature.The clinical prognosis of the two groups was observed.Results When compared with the control group,patients in the observation group got a lower rate of new onset renal injury(16.00%vs 34.00%,P=0.038);a lower rate of new onset gastrointestinal dysfunction(12.00%vs 28.00%,P=0.046);a reduced mechanical ventilation time[(14.82±7.78)vs(18.64±8.12)d,P=0.018];a decreased continuous blood filtration[(12.98±6.20)vs(18.56±10.92)d,P=0.002];and a shorter hospital duration[(43.28±10.72)vs(50.82±12.74)d,P=0.002].No significant difference was found in the APACHEⅡscore between the two groups at admission and at the time of puncture[(9.88±2.40)vs(9.46±2.35),P=0.378 and(10.30±3.07 vs(10.54±2.96),P=0.692].At 7 and 14 days after the puncture,the APACHE II score in the observation group was significantly lower than that in the control group[(9.32±2.49)vs(10.56±2.80),P=0.021 and(6.20±2.54 vs(8.42±2.48),P<0.01].Conclusions A step-up drainage combined with constant temperature lavage can reduce the incidence of new renal failure and gastrointestinal dysfunction in infected pancreatic necrosis patients and improve the clinical prognosis of the patients.