CRRT治疗急性重症胰腺炎并发急性肾功能衰竭的疗效评价

Evaluation of CRRT in the Treatment of Acute Severe Pancreatitis Complicated with Acute Renal Failure

目的分析与评价CRRT治疗急性重症胰腺炎并发急性肾功能衰竭的疗效。方法方便选取2015年9月-2019年9月该院急性重症胰腺炎并发急性肾功能衰竭患者60例,采取计算机随机进行分组,其中实验组(采用CRRT)30例,对照组(采用传统血液透析)30例。对比两组患者的临床疗效(无效、好转、治愈)、治疗前后的血清指标(乳酸、肌酐、C反应蛋白)以及APACHEⅡ评分(急性生理与慢性健康评分Ⅱ),统计并对比两组患者的24 h尿量、肾上腺素使用情况及病死率。结果实验组总有效率为96.67%,高于对照组的总有效率(73.33%)(χ~2=6.405,P=0.011 <0.05)。实验组治疗后乳酸为(3.02±1.15)mmol/L、肌酐为(195.83±32.56)μmol/L、C反应蛋白为(53.22±8.55)mg/L;对照组上述数据分别为(4.51±1.98)mmol/L、(278.04±97.19)μmol/L、(78.52±12.57)mg/L(t=3.564、4.393、9.115,P=0.001、0.001、0.001)。实验组治疗后APACHEⅡ评分为(15.38±4.03)分、对照组的APACHEⅡ评分为(19.03±5.25)分,实验组的APACHEⅡ评分低于对照组(t=3.021,P=0.004 <0.05)。实验组24 h尿量为(1 281.36±103.05)mL,对照组24 h尿量为(1208.88±68.87)mL,实验组24 h尿量明显高于对照组(t=3.203,P=0.002 <0.05)。实验组的肾上腺素使用率为26.67%(χ~2=5.554,P=0.018)、病死率为6.67%(χ~2=7.954,P=0.005 <0.05),均低于对照组(肾上腺素使用率56.67%,病死率36.67%)。结论急性重症胰腺炎并发急性肾功能衰竭患者采用CRRT治疗的疗效更显著,可以有效提高治疗总有效率,改善血清指标与APACHEⅡ评分,增大24 h尿量,减少肾上腺素的使用率,降低病死率。

Objective Analysis and evaluation of CRRT in the treatment of acute severe pancreatitis complicated with acute renal failure. Methods Sixty patients with severe acute pancreatitis complicated with acute renal failure in the hospital from September 2015 to September 2019 were conveniently selected randomly divided into experimental group(CRRT) of 30 cases and control group(traditional hemodialysis) of 30 cases. The clinical efficacy(inefficiency, improvement, cure), serum indicators(lactic acid, creatinine, C-reactive protein) and APACHE II score(acute physiology and chronic health score II)of the two groups were compared before and after treatment. The 24 h urine volume, adrenaline use and mortality of the two groups were counted and compared. Results The total effective rate of the experimental group was 96.67%, which was higher than the total effective rate of the control group(73.33%) (χ~2=6.405,P =0.011 <0.05). The lactic acid in the experimental group was(3.02±1.15) mmol/L, the creatinine was(195.83 ±32.56)μmol/L, and the C-reactive protein was(53.22±8.55) mg/L. The above data of the control group were(4.51±1.98)mmmol/L,(278.04±97.19)μmol/L,(78.52±12.57)mg/L(t=3.564, 4.393, 9.15,P=0.001, 0.001,0.001). The APACHE II score of the experimental group was(15.38±4.03)points,the APACHE II score of the control group was(19.03±5.25)points, and the APACHEII score of the experimental group was lower than that of the control group(t=3.021,P=0.004 <0.05). The urine volume of the experimental group was(1 281.36±103.05)mL, and the urine volume of the control group was(1 208.88±68.87)mL. The urine volume of the experimental group was significantly higher than that of the control group(t=3.203,P=0.002 <0.05). The epinephrine use rate of the experimental group was 26.67%(χ~2=5.554,P=0.018), and the case fatality rate was 6.67%(χ~2=7.954,P=0.005 <0.05), which was lower than the control group(adrenalin use rate 56.67%, case fatality rate 36.67%). Conclusion CRRT is more effective in the treatment of severe acute pancreatitis complicated with acute renal failure. It can effectively improve the total effective rate of treatment, improve serum indicators and APACHE II score, increase 24 h urine volume, reduce the use rate of adrenaline and mortality.