摘要
目的:探讨连续性血液净化(CBP)联合腹膜透析(PD)对非手术治疗的重症急性胰腺炎(SAP)的治疗效果。方法:23例患者,随机分治疗组及对照组。治疗组为综合治疗+CBP+PD治疗方法,CBP采用连续性静脉—静脉血液滤过(CVVH)或高容量血液滤过(HVHF),每疗程48—72h,每例患者1-3个疗程不等。PD采用间歇性腹膜透析(IPD),每d12-18周期,每次1000ml。对照组仅综合治疗。观察两组患者在病程的不同时间的腹水淀粉酶,APACHEⅡ评分,Balthazar CT分级评分情况及腹痛缓解的的时间。结果:两组患者治疗前年龄,APACHEⅡ评分,Balthazar CT分级评分无显著差异性。在治疗开始后24h,48h及一周后的APACHEⅡ评分中,治疗组显著低于对照组(8.6±3.2 vs 12.3±3.6,P<0.05;5.2±1.1 vs 8.7±1.6 P<0.01;5.0±2.5 vs 7.4±3.2 P<0.05)。在治疗开始后24h及48h的腹水淀粉酶比较(1360±320u vs 1763±425u P<0.01;853±128u vs 1260±357u P<0.01)及腹痛缓解时间上(10.5±3.6h vs 25.5±4.9h P<0.01),治疗组亦显著低于对照组。不仅如此,在治疗后的两周Balthazar CT分级评分有显著差异(2.0±1.5 vs 3.5±1.2 P<0.01)。观察组死亡率33.3%,对照组死亡率50%。结论:CVVH或HVHF联合IPD对SAP及其导致的全身全身炎症反应综合征(SIRS)乃至多器官功能障碍综合征(MODS)有确切的治疗作用,能缓解临床症状,改善预后。
Objective：To observe the effective of CBP associated with PD on the treatment of SAP.Methods：23 patients with SAP were randomly divided into control group and study group.Patiens in study group were treated with general methods and CBP associated with PD.CBP were CVVH or HVHF.48- 72h per treatment program.1 - 3 treatment program per case.PD were IPD.12 - 18 periods per day and 1000ml per time.Patients in control group were treated just with general methods. The amylase in ascites, APACHE Ⅱ grading mark, Balthazar CT grading mark and remission time of abdominal pain of all paitents in different time of couise were observed. To observe the effective of CBP associated with PD on the treatment of SAP.Results：Age,APACHE Ⅱ grading mark and Balthazar CT grading mark have significant difference.APACHE grading mark of study group after 24 hours,48 hours and one week were low than that in control group（8.6 ± 3.2 vs 12.3± 3.6,P〈0.05;5.2± 1.1vs 8.7± 1.6 P 〈 0.01 ;5.0 ± 2.5vs7.4 ±3.2 P 〈 0.05）.The amylase in ascites（1360 ± 320 u vs1763 ± 425 u P 〈0.01;853± 128 u vs 1260 ± 357u P 〈 0.01）and remission time of abdominal pain（10.5 ± 3.6h vs 25.5±4.9h P 〈 0.01）of study group after 24 hours and 48 hours were low than that in control group. Moreover, the Balthazar CT grading mark after two weeks has significant difference（2.0 ± 1.5 vs 3.5 ± 1.2 P 〈 0.01） .Death rates in control group and study group were 50% and 30% separately. Condusions： CBP （CVVH or HVHF）asssociated with IPD is effective in treatment of SAP and it＇ s complications（SIRS or MODS） .The clinical symptom was remissed and prognosis was improved.
出处
《航空航天医药》
2008年第3期131-133,共3页
Aerospace Medicine
