腹膜透析在急性出血坏死性胰腺治疗中的应用

Application of peritoneal dialysis in treatment of patients with acute hemorrhagic necrotic pancreatitis

目的 :探讨腹膜透析 (PD)对急性出血坏死性胰腺炎(AHNP)的疗效及机制。方法 :24例AHNP患者在接受常规综合治疗的同时 ,行间歇性腹膜透析 (IPD)治疗。PD治疗前后监测病情及生化指标的变化 ,并测定血中细胞因子和炎症介质水平。结果 :PD治疗后患者心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解 ;总胆红素 (TB)、淀粉酶 (AMS)、脂肪酶 (LPS)、尿素氮 (BUN)、肌酐 (Cr)明显降低 ;血肿瘤坏死因子α(TNF-α)、白介素 -1β(IL-1β)、C -反应蛋白 (CRP)和内毒素水平明显下降 ;24例患者中19例治愈 ,5例死亡 ,病死率为20 8%。结论 :PD治疗能降低AHNP并发MODF的病死率 ,提高抢救成功率。

Objective:To explore the efficacy and mechcanism of the peritoneal dialysis(PD)in treatment of acute hemorrhagic necrotic pancreatitis(AHNP).Methods:24AHNP patients was treated with conventional theraphy companied by intermittent peritoneal dialysis(IPD).During PD,the patients conditions and markers of biochemistry were observed,and the serum concertrations of cytokine and inflammatory factor were measured.Results:After PD,the patients symptoms such as tachycardia,respiratory distress,abdominal pain were remission.The serumlevels of total bilinogen(TB),amylase(AMS),lipopolyse(LPS),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),C-reactive protein(CRP)and endotoxin were decreased significantly.Five patients died.The mortality rate was20.8%.Conclusion:PD Can decrease mortality rate of AHNP with MODF.