进一步改善重症急性胰腺炎预后的探讨

Discussion of improve the prognosis of severe acute pancreatitis.

目的 探讨早期如何运用血液滤过改善重症急性胰腺炎 (SAP)的预后。方法 1997年 4月至 2 0 0 2年7月采用血液滤过治疗SAP49例。其中普通型SAP(CSAP组 ) 3 4例 ,暴发性SAP(FSAP组 ) 15例 ,分析血滤参数和观察病人的手术率、非手术治愈率、总体存活率、住院时间和费用。结果 SAP和FSAP的血滤时间分别为 (5 45± 3 3 8)h与 (2 3 7± 2 2 1 6)h ,血液净化量、超滤液量和血滤器数目分别为 (75 0± 18 7)L与 (3 0 8 0± 3 61 6)L ;(2 2 45 5± 1186 1)mL与 (4 83 4 1± 2 83 2 8)mL ;(2 6± 1 3 )与 (2 9± 1 5 )个。CSAP组和FSAP组的中转手术率、非手术治愈率、总体存活率、住院时间、住院费用分别为 2 0 6% (7/ 3 4)与 73 3 % (11/ 15 ) ;10 0 % (2 7/ 2 7)与 2 5 % (1/ 4) ;91 2 % (3 1/ 3 4)与 60 % (9/ 15 ) ;(3 2 3± 10 4)天与 (13 5± 5 6 9)天 ;(5 3 4± 3 0 1)万元与 (2 9 3± 11 9)万元。结论 发病 72h内 ,重症胰腺炎加用短时血液滤过和暴发性胰腺炎急诊手术引流腹腔。

Objective To investigate how to improve the prognosis of severe acute pancreatitis (SAP) at the early stage through hemofiltration.Methods Forty nine patients with SAP treaded by hemofiltration were analysed to find the efficacy,indications and the factors affected.First group(Ⅰ Group,CSAP) was common severe acute pancreatitis,34 patients;Second group(Ⅱ Group,FSAP) was fulminant severe acute pancreatitis,15 patients.The operation rate,non operation rate,survival rate were analysed among two Groups;and to find how to reach the best efficacy through modulation of hemofiltrating parameters.Results Duration for SVVH(short veno venous hemofiltration)and CVVH(continuous veno venous hemofiltration)is (5 45±3 38) vs (237±221 6)h,respectively.And anomg two Groups,the volume of blood purification,ultrafiltrate and the number of filters were (75 0±18 7) vs (308 0±361 6)L;(2245 5±1186 1) vs (4834 1±2832 8)mL;(2 6±1 3) vs (2 9±1 5),respectively.Additionally,operation rate,non operation curing rate,survival rate,hospital stay and costs were 20 6%(7/34) vs 73 3%(11/15);100%(27/27) vs 20%(1/4);91 2%(31/34) vs 60%(9/15);(32 3±10 4) vs (135±56 9)days;(53400±30100) vs (29300±11900) RMB Dollars.Conclusion SVVH and CVVH as well as surgical drainage used to treat CSAP and FSAP,respectively,are good measures to improve the prognosis of the disease within 72 hours from onset of the disease.