连续性肾脏替代治疗联合经内镜鼻胆管引流治疗急性重症胆源性胰腺炎的临床研究

Clinical study of continuous renal replacement therapy combined with endoscopic nasobiliary drainage for acute severe biliary pancreatitis

目的探讨连续性肾脏替代治疗(CRRT)联合经内镜鼻胆管引流(ENBD)治疗急性重症胆源性胰腺炎(ASBP)的临床疗效。方法回顾性分析2015年1月至2018年1月宝鸡市人民医院收治的76例ASBP患者的临床资料,其中接受常规CRRT治疗者32例,接受CRRT联合ENBD治疗者44例。对两种治疗方式的腹痛缓解时间、胃肠减压时间、重症监护室(ICU)治疗时间、呼吸机治疗时间、并发症发生率和死亡率进行对比研究,同时对两种治疗前后的实验室参数(白细胞、血小板、降钙素原、C-反应蛋白、总胆红素、丙氨酸转氨酶、白蛋白、血乳酸)及APACHEⅡ评分进行对比研究。结果 CRRT联合ENBD组患者在腹痛缓解时间、胃肠减压时间、呼吸机治疗时间、ICU住院时间和ARDS和ARF并发症发生率方面均优于CRRT组(P <0. 05),治疗后实验室参数(白细胞、血小板、降钙素原、C-反应蛋白、总胆红素、丙氨酸转氨酶、白蛋白、血乳酸)及APACHEⅡ评分亦优于单纯CRRT组(P <0. 05)。结论 CRRT联合ENBD治疗ASBP比单纯应用CRRT更加有效。

Objective This study aimed to report the clinical efficacy of continuous renal replacement therapy( CRRT) in combination with endoscopic nasobiliary drainage( ENBD)( CRRT + ENBD) in the treatment of acute severe biliary pancreatitis( ASBP). Methods From January 2015 to January 2018,the data of 32 patients with ASBP receiving conventional CRRT and 44 patients with ASBP receiving CRRT combined with ENBD in Baoji People’ s Hospital were retrospectively analyzed. The time of abdominal pain relief,gastrointestinal decompression,intensive care unit( ICU),ventilator treatment,complication rate and mortality were compared. The laboratory parameters( leukocyte, platelet, procalcitonin, C-reactive protein, total bilirubin, alanine aminotransferase,albumin,blood lactate) and AP before and after treatment were also compared. The ACHE Ⅱ scores were compared.Results The time of abdominal pain relief,gastrointestinal decompression,ventilator treatment,ICU hospitalization and complication rate in CRRT + ENBD group were better than those in CRRT group( P < 0. 05). After treatment,the laboratory parameters( white blood cells,platelets,procalcitonin,C-reactive protein,total bilirubin,alanine aminotransferase,albumin,blood lactate),incidence of complications of ARDS and ARF and APACHE Ⅱ scores in CRRT + ENBD group were also better than those in CRRT group( P < 0. 05). Conclusion CRRT in combination with ENBD is more effective in the treatment of ASBP than CRRT alone.