CRRT在治疗重症急性胰腺炎中的应用

Application of continuous renal replacement therapy in the treatment of severe acute pancreatitis

目的探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组,每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例,观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果2组患者治疗后5~7 d内APACHEⅡ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72)vs(11.24±2.76)mmol/L]、血肌酐[(69.51±15.03)vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693,5.924,7.440,9.362,5.235,6.801,5.018,P均<0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs(5.22±1.51)d]、体征指标稳定时间[(2.52±1.38)vs(4.39±1.50)d]、胃肠功能恢复时间[(4.48±1.27)vs(6.21±1.55)d]以及ICU住院时间[(15.03±2.21)vs(18.44±3.27)d]均低于对照组,结果分析差异有统计学意义(t=5.954,5.190,4.884,4.888,P均<0.05)。结论与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy(CRRT)in the treatment of severe acute pancreatitis(SAP).Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out.The patients were divided into the observation group and the control group ac-cording to different treatment regimens,with 32 cases in each group,and the baseline levels of the two groups were consist-ent.Patients in the control group were treated with conventional medical treatment,and the patients in the observation group were treated with CRRT on the basis of the control group,and the efficacy of the two groups were analyzed and compared.Results The APACHE II scores[(11.02±3.14)vs(13.98±3.27)]、triglyceride[(4.02±1.05)vs(5.62±1.11)mmol/L],C-reactive protein[(88.25±6.73)vs(104.41±10.28)ng/L],procalcitonin[(13.12±4.33)vs(18.55±3.96)ng/mL],blood urea nitrogen[(7.33±1.72)vs(11.24±2.76)mmol/L],serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L]of patients in both groups were significantly decreased within 5-7 days after treat-ment compared with those before treatment,and the decrease of the above indicators in the observation group was significantly greater than that in the control group,P<0.05.The remission time of symptoms[(3.15±1.26)vs(5.22±1.51)d],the stabilization time of signs[(2.52±1.38)vs(4.39±1.50)d],the recovery time of gastrointestinal function[(4.48±1.27)vs(6.21±1.55)d]and the length of ICU stay[(15.03±2.21)vs(18.44±3.27)d]in the observation group were lower than those in the control group,and the analysis of the results was statistically significant(t=5.954,5.190,4.884,4.888,all P<0.05).Conclusions Compared with conventional medical treatment,additional CRRT treatment can significantly improve the inflammatory indicators of SAP,help patients survive from critical state of SAP,which has posi-tive clinical value.