连续性血液净化治疗重症急性胰腺炎机制的临床研究

Mechanisms of treating severe acute pancreatitis with continuous blood purification

目的 研究连续性血液净化 (CBP)治疗重症急性胰腺炎 (SAP)的机制。方法 选择 10例SAP患者给予CBP治疗 ,观察治疗前、中、后患者血液生化指标、血常规、血气分析和肿瘤坏死因子α(TNF -α) ,并进行APACHEⅡ、SAPSⅡ和MODS评分。结果 与治疗前相比较 ,CBP治疗第 2日晨和CBP治疗结束后次日晨患者APACHEⅡ、SAPSⅡ和MODS评分较治疗前降低 ,治疗后氧合指数 (PO2 /FiO2 )有明显改善 ,压力调整心率 (PAHR)治疗过程中较治疗前降低。CBP治疗次日晨PO2 /FiO2 及PAHR与治疗前的差值 ,和CBP脱水量呈正相关 ;CBP治疗第 2日晨 ,脱水量与MODS评分呈负相关。CBP治疗过程中血BUN、Cr和尿酸均降低 ,治疗时间越长 ,降低越明显。CBP治疗后TNF -α降低不明显。结论 CBP治疗后心、肺功能的改善与脱水后组织器官间质水肿减轻有关 ,但并非脱水越多越好。从清除BUN、Cr来看 ,CBP治疗时似乎越长越好 ;但对BUN、Cr正常的患者 ,治疗时间可以缩短。治疗前、中、后的TNF -α变化不支持CBP治疗SAP是通过清除TNF -α而起作用的观点。

Objective To study the mechanisms of treating severe acute pancreatitis (SAP) with continuous blood purification (CBP). Methods 10 SAP patients were chosen and treated with CBP. Blood biochemical index, routine, gas analysis and tumor necrosis factor-α(TNF-α) were tested in pre-,intra- and post-treatment of CBP. Meanwhile, APACHEⅡ, SAPSⅡ and MODS score were graded. Results Compared with pre-treatment, APACHEⅡ, SAPSⅡ and MODS scores decreased on the second morning of intra-treatment and the next morning of post-treatment. Oxygenation index (FiO 2/PO 2) was improved obviously. Pressure-adjusted heart rate (PAHR) during treatment were decreased. It was positive correlation with the amount of dehydration by CBP that the difference of the PO 2/FiO 2 and PAHR between the next morning pretreatment and intra-treatment. The amount of dehydration was negative correlation with MODS score on the second morning during treatment. BUN, Cr and uric acid was decreased during CBP and the longer time was, the lower scores were. TNF-α was not decreased significantly after treatment. Conclusions The improvement of cardiac and pulmonary function was concerned with relieving interstitial edema of organization after dehydration by CBP. But it is not right that the more dehydration was, the better patient was. The longer time was better for clearing BUN and Cr. The time of CBP should be shortened for the patients with normal BUN and Cr. The mechanisms of treating SAP with CBP was the removal of TNF-α which was not supported according to the changes of TNF-α before, during and after treatment.