首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 93 毫秒
1.
连续性血液净化(CBP)广泛应用于治疗各种危重症疾病如多器官功能不全综合征(MODS)、急性重症胰腺炎、全身炎症反应综合征(SIRS)及脓毒症(SEPSIS)等,并取得了显著疗效。CBP包括连续静静脉血液滤过(CVVH)、连续静静脉血液透析  相似文献   

2.
连续性血液净化与重症感染   总被引:36,自引:2,他引:34  
连续性血液净化(CBP)应用于临床,克服了传统间歇性血液透析(IHD)同时存在的“非生理性”治疗的缺陷,标志着一种新技术的诞生。近年来CBP系列技术日趋成熟,临床应用范围进一步扩大,尤其在创伤、感染、全身炎症反应综合征(SIRS)、脓毒症(Sepsis)、急性重症胰腺炎(ASP)等重症疾病的救治中取得了良好疗效。而迄今为止,很多关于拮抗炎症介质的药物治疗重症感染机制及疗效的回顾性或前瞻性研究均未获得令人满意的效果,这就是近几年来我们在实际工作中倡导CBP治疗重症感染的重要原因。  相似文献   

3.
朝亚 《中国老年学杂志》2012,32(18):4003-4004
重症急性胰腺炎(SAP)是一种临床常见危重病,发病后常伴发全身炎症反应〔1,2〕。老年患者器官功能逐渐衰退,同时合并的慢性疾病使器官功能进一步减退,处于临近衰竭的状态,一旦发生SAPS,则病情凶险、进展迅速,预后不良。连续性血液净化(CBP)是近年来血液净化领域的重要进展〔3〕,我院近3  相似文献   

4.
目的探讨连续性肾脏替代治疗(CRRT)血液灌流(HP)联合连续性静脉-静脉血液滤过治疗(HP/CVVH)、血浆置换(PE)联合连续性静脉-静脉血液滤过治疗(PE/CVVH)对高脂血症性重症急性胰腺炎(HLSAP)的治疗价值及效果评价。方法将68例HLSAP患者随机分为CVVH组、HP+CVVH组和PE+CVVH组,均予重症急性胰腺炎常规治疗,并分别予以单纯CVVH、HP+CVVH、PE+CVVH治疗。比较治疗前和治疗72 h后三组患者生命体征、APACHEⅡ评分、甘油三酯(TG)、C反应蛋白(CRP)、重要脏器功能指标变化值;CT检查评价治疗前与治疗1周后CT严重程度指数(CTSI)变化;记录治疗1周内主要并发症发生率、平均住院天数及死亡率。结果三组患者治疗前各项指标差异无显著性。但各组患者治疗后各项指标均有好转(P0.05),治疗72 h后三组间APACHEⅡ评分、血和尿淀粉酶比较差异均无统计学意义(P0.05);HP+CVVH、PE+CVVH两组与CVVH组比较其余实验室指标改善更明显(P0.05)。治疗1周后三组患者CTSI均较治疗前下降(P0.05),且HP+CVVH组和PE+CVVH组较CVVH组改善更明显(P0.05)。HP+CVVH组和PE+CVVH组较CVVH组临床情况更好,死亡率低,住院时间短(P0.05)。结论 HP、PE联合CVVH治疗较单纯CVVH治疗能够更快降低患者血TG水平,改善临床症状,可减少系统炎性反应综合征及多器官功能障碍综合征/多器官功能衰竭的发生,有效降低死亡率,减少住院时间。  相似文献   

5.
张河  首志雄  陈帅  宁军 《内科》2012,7(6):610-612
目的观察重症急性胰腺炎(severe acute pancreatitis,SAP)在常规治疗基础上进行连续性血液净化(continuous blood purification,CBP)治疗的效果。方法选择我院ICU中明确诊断为重症急性胰腺炎的患者55例,以行常规治疗的患者30例为对照组,在常规治疗基础上进行连续性血液净化治疗的患者25例为观察组,比较两组治疗72h后APACHEII评分、胰腺CT积分及各种血清生化指标变化情况。结果治疗72h后,与对照组比较,观察组患者APACHEⅡ评分、白细胞、血清淀粉酶、尿素氮、肌酐、C-反应蛋白、总胆红素均明显改善,差异均有统计学意义(P〈0.05)。结论连续性血液净化治疗可早期纠正SAP患者的全身炎症反应,改善全身状况,防止并发症的发生,能有效缓解病情。  相似文献   

6.
连续性血液净化治疗重症急性胰腺炎的新进展   总被引:1,自引:0,他引:1  
重症急性胰腺炎(SAP)占急性胰腺炎的15%-20%,但是病死率高达15%~25%。近年来,在传统治疗的基础上加用连续性血液净化(CBP)治疗SAP的研究取得了很大进展,现就CBP治疗SAP的新进展综述于后。  相似文献   

7.
连续性血液净化在非肾脏病患者中的应用   总被引:32,自引:2,他引:30  
近年来,连续性血液净化(CBP)技术日趋成熟,在复杂性急性肾功能衰竭(ARF)中的应用已形成共识,而其临床应用范围已远远超过了肾脏替代治疗领域,扩展至非肾脏病领域,成为各种危重病救治中多器官支持疗法(MOST)手段之一.CBP在非肾脏病中的应用并非间歇性血液透析(IHD)的一种简单改良,非肾脏病危重患者的治疗不同于一般肾脏病,前者病情往往重笃,需要平衡渐进性治疗.另外,要使重症患者内环境平衡,不仅需行血液净化,还应彻底纠正代谢紊乱及清除炎症介质.这是CBP治疗非肾脏疾患的理论基础.  相似文献   

8.
持续血液净化疗法在重症急性胰腺炎中的作用   总被引:3,自引:0,他引:3  
重症急性胰腺炎(serve acute pancreatitis,SAP)是常见的急腹症,其发病急、并发症高、病死率高.我院中西医结合治疗SAP二十多年,死亡率降到10.77%,居全国最低,但近几年死亡率没有突破性进展.连续性血液净化(continuous blood purification,CBP)是指所有缓慢、连续清除体内水和溶质的一组治疗方式,这是近20年来血液净化领域的新成就之一,也是近年来急救医学的重要进展,他不但应用在急慢性肾功能衰竭患者的治疗中,而且已被广泛地应用于非肾脏疾患,本文将总结急性胰腺炎发病机制及连续性血液净化对该机制的治疗作用和机制.  相似文献   

9.
目的探讨连续性血液净化(CBP)对老年重症脓毒血症急性肾损伤(AKI)患者的临床疗效。方法回顾性分析76例老年重症脓毒血症AKI患者的临床资料,分为CBP治疗组39例和基础治疗组37例,分析两组治疗前后体征、血常规、肾功能、炎症细胞因子变化、急性生理学及慢性健康状况评分(APACHE)Ⅱ。结果 CBP治疗组治疗前后,临床体征、血常规、肾功能、炎症细胞因子、APACHEⅡ变化均显著优于基础治疗组(P0.05)。结论对老年重症脓毒血症AKI患者采用CBP可有效缓解炎症,改善临床指标,可改善血流动力学指标,稳定血流动力学,可使肾功能指标得到明显改善,使肾功能得以加强,实现降低死亡率、提高生存率的最终目标。  相似文献   

10.
危重心肾综合征( SCRS)患者均呈现重度心力衰竭和肾衰竭,临床上常出现少尿、无尿、高度浮肿、端坐呼吸、心律失常或电解质紊乱,常规的利尿剂和正性肌力药物往往难以奏效,连续性血液净化(CBP)在治疗中起到了关键作用危重心肾综合征临床上尚无统一的诊断标准[1],我们对连续性静脉-静脉血液滤过透析( CVVHDF)和连续静脉静脉血液滤过(CVVH)对27例SCRS患者的临床疗效进行比较.  相似文献   

11.
连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值   总被引:20,自引:0,他引:20  
Shen Q  Gan H  Du XG  Li ZR  Chen DJ 《中华内科杂志》2003,42(7):483-485
目的 观察在传统治疗重症急性胰腺炎(SAP)的同时行连续性静脉-静脉血液滤过(CVVH)的疗效。方法 53例SAP患者在接受传统治疗的同时行CVVH,每次至少持续24h。监测CVVH前后病情及血清淀粉酶、脂肪酶的变化,行动脉血气分析和APACHlE Ⅱ评分,测血中内毒素水平。结果 CVVH治疗后患者心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解,APACHEⅡ评分明显降低,淀粉酶、脂肪酶、尿素氮、肌酐明显降低,酸中毒、低氧血症纠正。CVVH治疗6h后,血中内毒素水平下降,24h后又恢复至治疗前的水平。53例患者中38例痊愈出院,存活率为71.7%。结论 在传统治疗SAP的同时行CVVH,能提高抢救的成功率,降低病死率。  相似文献   

12.
目的评价连续性静脉-静脉血液滤过(CVVH)治疗急性重症胰腺炎的有效性和安全性。方法应用计算机检索电子数据库:PubMed(1980~2011年)、中国期刊全文数据库(CNK:1990~2011年)、万方数据库(1980~2011年),并手工检索Cochrane图书馆。采用Cochrane系统评价员手册4.2.2推荐的方法纳入文献,并对其进行Meta分析。结果共有12篇文章纳入研究。共纳入383例患者,其中CVVH治疗者(CVVH组)208例,常规非手术治疗者(对照组)175例。对12个研究进行了Meta分析。结果显示:与常规非手术组相比,CVVH组明显提高了总体治愈率[OR=3.24,95%CI(1.69,6.22),P=0.0004],降低了总体病死率[OR=0.32,95%CI(0.15,0.68),P=0.003],缩短了腹痛、腹胀症状改善时间,降低了并发症发生率。结论根据目前证据,早CVVH治疗SAP患者可能是安全有效的。目前所获研究仅来自中国且方法学质量较低,需要进一步开展高质量大样本的RCT来评价CV-VH治疗SAP有效性和安全性。  相似文献   

13.
Background. Continuous veno-venous haemofiltration (CVVH) could be reasonable for attenuation of systemic complications in severe acute pancreatitis (SAP). The aim of the study was implementation and feasibility assessment of the CVVH in the treatment protocol of SAP. Patients and methods. CVVH was applied to 111 SAP patients during 2000–2005. APACHE II, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), serum lipase, C-reactive protein (CRP), complication rate and main outcomes were analysed comparing two periods. Results. Overall, 39 patients corresponded to Balthazar grade E SAP and 72 patients to necrotizing SAP (NSAP), with an average APACHE II score of 7 and 8.5, respectively, on admission. CVVH was started within 48 h in 82% of patients. Duration of CVVH was significantly augmented in NSAP patients during the routine period, comprising 92 h (p=0.006). The clinical presentation of SIRS and MODS was similar in both periods, with more initial pulmonary dysfunctions in NSAP (p=0.048). Peripancreatic infection decreased in the routine period; surgical interventions were performed in 34.8% vs 72.4% of patients. Hospital stay comprised on average 15.9 days for grade E SAP and 29.4 days for NSAP in the routine period, with overall mortality of 10.26% and 30.5%, respectively. Discussion. Application of CVVH in the treatment protocol of SAP is obscure due to relative invasiveness, a poorly understood mechanism of action and scarce clinical experience. We conclude that early pre-emptive application of CVVH is safe and feasible in the treatment of SAP. Duration of the procedure seems to be essential. Randomized clinical trials are justified. Our results are in favour of clinical application of CVVH in the treatment of SAP.  相似文献   

14.
Objective: Acute pancreatitis (AP) ranges from a mild and self-limiting disease to a fulminant illness with significant morbidity and mortality. Severe acute pancreatitis (SAP) is defined as persistent organ failure lasting for 48?h. We aimed to determine the factors that predict survival and mortality in patients with SAP.

Methods: We reviewed a consecutive series of patients who were admitted with acute pancreatitis between January 2003 and January 2013. A total of 1213 cases involving 660 patients were evaluated, and 68 cases with SAP were selected for the study. Patients were graded based on the Computer Tomography Severity Index (CTSI), the bedside index for severity (BISAP), and Ranson’s criteria.

Results: The frequency of SAP was 5.6% (68/1213 cases). Among these patients, 17 died due to pancreatitis-induced causes. We compared several factors between the survivor (n?=?51) and non-survivor (n?=?17) groups. On multivariate analysis, there were significant differences in the incidence of diabetes mellitus (p?=?.04), Ranson score (p?=?.03), bacteremia (p?=?.05) and body mass index (BMI) (p?=?.02) between the survivor and non-survivor groups.

Conclusions: Bacteremia, high Ranson score, DM, and lower BMI were closely associated with mortality in patients with SAP. When patients with SAP show evidence of bacteremia or diabetes, aggressive treatment is necessary. For the prediction of disease mortality, the Ranson score might be a useful tool in SAP.  相似文献   

15.
To evaluate the effects of pulse high‐volume hemofiltration (PHVHF) on severe acute pancreatitis (SAP) with multiple organ dysfunction syndrome (MODS). Thirty patients were divided into two groups: PHVHF group and continuous venovenous hemofiltration (CVVH) group. They were evaluated in terms of clinical symptoms, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, simplified acute physiology (SAPS) II score and biochemical changes. The levels of IL‐6, IL‐10 and TNF‐α in plasma were assessed by ELISA before and after treatment. The doses of dopamine used in shock patients were also analyzed. In the two groups, symptoms were markedly improved after treatment. Body temperature (BT), breath rate (BR), heart rate (HR), APACHE II score, SOFA score, SAPS II score, serum amylase, white blood cell count and C‐reactive protein were decreased after hemofiltration (P < 0.05). The PHVHF group was superior to the CVVH group, especially in APACHE II score, CRP (P < 0.01), HR, temperature, SOFA score and SAPS II score (P < 0.05). The doses of dopamine for shock patients were also decreased in the two groups (P < 0.05), with more reduction in the PHVHF group than the CVVH group (P < 0.05). The levels of IL‐6, IL‐10 and TNF‐α decreased (P < 0.05) in the PHVHF group more significantly than the CVVH group (P < 0.01). PHVHF appears to be superior to CVVH in the treatment of SAP with MODS.  相似文献   

16.
目的探讨高脂血症(特别是高三酰甘油血症)、微循环障碍与急性胰腺炎严重度的关系,加强对高脂血症性急性胰腺炎(hyperlpidemic acute pancreatitis,HLAP)的认识。方法将我院2006年1月~2009年8月收治的143例急性胰腺炎患者,按临床表现分为轻型急性胰腺炎(mild acute pancreatitis,MAP)82例,占57.34%,重症急性胰腺炎(severe acute pancreatitis,SAP)61例,占42.66%;按病因分为脂源性胰腺炎(hyperlipemia acute pancreatitis,HLAP)42例,占29.37%,非脂源性胰腺炎(non-hyperlipemia a-cute pancreatitis)101例,占70.63%。探讨高脂血症与MAP和SAP的关系。结果脂源性胰腺炎与非脂源性胰腺炎组比较,全血黏度(高切)、全血黏度(低切)、CRP差异有统计学意义(P〈0.001),脂源性胰腺炎组并发症发生率较高且严重。结论故高三酰甘油(TG)血症、微循环障碍是AP持续和加剧损害的因素。  相似文献   

17.
AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP). METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study. RESULTS: Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs116.3±7.8 kPa,P<0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio. CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.  相似文献   

18.
目的 评价持续低效血液透析滤过(SLEDF)对重症急性胰腺炎(SAP)患者肠黏膜屏障功能及免疫功能的影响。方法 将51例SAP患者随机分为持续静脉静脉血液滤过(CVVH)组25例和SLEDF组26例,在常规治疗基础上分别接受CVVH和SLEDF治疗。比较两组患者预后、血、尿淀粉酶恢复正常时间、治疗前和治疗第2、4、8、14d血D-乳酸、内毒素(ET)、二胺氧化酶(DAO)、CD3+、CD4+、CD8+T淋巴细胞水平、CD4+/CD8+T淋巴细胞比值及血液净化相关并发症发生情况。结果 两组患者死亡率、血、尿淀粉酶恢复正常时间比较差异均无统计学意义,血D-乳酸、ET、DAO、CD3+、CD4+、CD8+T淋巴细胞水平和CD4+/CD8+T淋巴细胞比值在治疗前和治疗第2、4、8、14d比较差异均无统计学意义(P>0.05)。两组患者治疗第4、8、14d D 乳酸、ET和DAO水平均较同组治疗前降低,第8、14d均较同组治疗第4d降低(P<0.05)。两组患者治疗第4、8、14d的CD3+、CD4+、CD8+T淋巴细胞水平和CD4+/CD8+T淋巴细胞比值均较同组治疗前升高,第8、14d均较同组治疗第4d升高(P<0.05);两组患者治疗第4、8d的CD8+T淋巴细胞水平较同组治疗前降低,第8、14d较第4d降低(P<0.05)。结论 SLEDF和CVVH改善SAP患者肠道屏障功能障碍和免疫功能异常的作用相似,其中SLEDF操作方便,医疗费用低,值得临床推广。  相似文献   

19.
重症急性胰腺炎(SAP)是临床常见的危重疾病,越来越多的证据表明,SAP是胰腺自身消化启动的严重全身炎症反应性疾病,炎症细胞被过度激活并大量释放细胞因子,由此产生的细胞因子级联反应是SAP病情加重的重要原因。连续性血液净化(CBP)作为一种重要的辅助治疗措施,可削弱炎症介质峰值,稳定内环境,从而治疗SAP导致的多脏器功能损害,在缓解症状、降低并发症的发生率、缩短并发症的持续时间、降低病死率方面起着重要的作用,在改善患者预后方面效果良好。本文结合SAP的发病特点,对CBP治疗SAP的机制、目前临床研究及进展作一综述。  相似文献   

20.
AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号