连续性高容量血液滤过对重症急性胰腺炎患者C-反应蛋白的影响

Continuous high-volume hemofiltration on C-reactive protein in severe acute pancreatitis

目的 :C 反应蛋白 (C reactiveprotein ,CRP)是一种急性时相蛋白 ,是早期评价急性胰腺炎严重程度及其预后的有效血清学参数 ,本文研究了连续性高容量血液滤过对重症急性胰腺炎 (SAP)患者CRP的影响和临床意义。 方法 : SAP患者 2 3例 ,男性 15例 ,女性 8例 ,平均年龄 2 7～ 73(47 7± 13 6 )岁 ,其诱因分别为胆源性胰腺炎 15例 ,酒精性胰腺炎 2例 ,高脂血症性胰腺炎 2例 ,兼有多种因素者 1例 ,原因不明者 3例。入院时APACHEⅡ评分为 6～ 2 0 (11 6± 4 36 )分。合并急性呼吸窘迫综合征 /急性肺损伤 (ARDS/API) 2 2例 ,呼吸机治疗 13例 ,少尿型急性肾衰 (ARF) 5例 ,低血压休克 5例 ,胰性脑病 6例。患者入院明确诊断之后 ,即在床边行连续性高容量静脉 静脉血液滤过 (CHVHF) ,连续治疗 72h不间断。所用滤器为AN6 9膜 ,面积 1 2m2 ,每隔 2 4h更换一次。治疗中血流量为 2 5 0ml/min ,置换液量定为 4 0 0 0ml/h ,前稀释方式输入 ,超滤量根据治疗量和患者容量负荷情况设定。 结果 :2 3例患者中 ,存活 2 0例 (存活率 87 0 % ) ;死亡 3例 (死亡率 13 0 % )。实际CHVHF治疗时间为 6 7～ 76h ,平均(71 95± 1 33)h ,实际超滤率为 (396 6 4± 2 4 0 2 )ml/h。行CHVHF治疗后发热、心动过速等症状明显好转。

Objective:The acute-phase reactant C-reactive protein (CRP) is a marker of inflammatory response, it is currently a serum variable of choice for early and accurate assessment of severity in severe acute pancreatits (SAP) This study was performed to evaluate the influence of continuous high-volume hemofiltration (CHVHF) on serum CRP levels in SAP patients Twenty-three SAP patients(15 males and 8 females) with an average age of 27～73(47 7±13 6) were included CHVHF was started 1～7(3 48±1 45)days after onset of the disease, APACHE II score before the treatment was 6～20(11 6±4 36) Twenty-two of the patients were complicated with acute respiratory distress syndrome/acute pulmonary injury(ARDS/API), and in 13 of them mechanical ventilation was needed Five of the patients complicated with acute renal failure(ARF), and 5 patients with shock CHVHF was performed continuously for 67～76 hours, AN69 hemofilters (1 2 m 2) were used and changed every 24 hours The ultrafiltration rate was (3 966 4±240 2)ml/h Clinical symptoms of SAP were relieved quickly on CHVHF, including decreased body temperature, heart rate and increased arterial oxygen concentration Twenty (87 0%) of the patients survived, and 3 (13 0%) patients died The APACHE Ⅱ scores were significantly decreased in the survivals but not significant in the non-survivals CRP level decreased gradually in the survivals, 48h after CHVHF it was significantly lower than pre-treatment ( P <0 05), and very significantly lower than pre-treatment 60h and 72h after CHVHF ( P <0 01) While in the dead 3 patients, CRP was decreased in only one of them, but increased in the other 2 patients No correlation was found between CRP and APACHE II score in the two groups.CHVHF was effective in alleviating symptoms of SAP and decreasing the acute-phase reactant CRP level in the SAP patients Sequential determination of CRP serum levels in SAP patients treated with CHVHF is of clinical significance in the evaluation of the prognosis