CRRT治疗重症急性胰腺炎的时机选择及对病情转归的影响

Timing selection of CRRT for treating severe acute pancreatitis and its effect on outcome

目的分析连续性肾脏替代疗法(CRRT)治疗重症急性胰腺炎(SAP)的时机选择及对病情转归的影响。方法回顾该院在2019年1月至2020年12月收治的75例SAP患者,按CRRT不同治疗时机分为两组,即A组(42例,确诊为SAP后立即采用CRRT治疗)与B组(33例,出现急性肾损伤后采用CRRT治疗),比较两组患者病情转归情况和相关实验室指标检测结果。结果A组患者机械通气时间、CRRT治疗时间、重症监护室住院时间、总住院时间短于B组,差异均有统计学意义(P<0.05)。治疗72 h后,A组患者血淀粉酶、腹内压、C反应蛋白水平低于B组,氧合指数高于B组,急性生理与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分低于B组,28 d病死率低于B组(P<0.05)。结论早期采用CRRT治疗SAP有显著效果,能阻止病情发展,改善患者预后。

Objective To analyze the timing selection of continuous renal replacement treatment(CRRT)in treating severe acute pancreatitis(SAP)and its impact on the disease outcome.Methods Seventy-five cases of SAP treated in this hospital from January 2019 to December 2020 were retrospectively analyzed.According to different treatment timing,the cases were divided into the group A(42 cases,immediately adopting CRRT after diagnosing SAP)and group B(33 cases,adopting CRRT after appearing acute kidney injury).The disease outcome and detection results of related laboratory indexes were compared between the two groups.Results The mechanical ventilation time,CRRT treatment time,intensive care unit stay time and total hospital stay time in the group A were shorter than those in the group B,and the differences were statistically significant(P<0.05).After 72 h treatment,serum amylase,intra-abdominal pressure and CRP level in the group A were lower than those in the group B,the oxygenation index was higher than that in the group B,APACHEⅡscore and SOFA score were lower than those in the group B,and the 28 d mortality rate was lower than that in the group B(P<0.05).Conclusion Early adopting CRRT for treating SAP has significant effect,can hold back the disease progress and improve the prognosis of the patients.