早期连续性肾脏替代治疗联合血液灌流预防急重症性胰腺炎急性肺损伤的临床研究

目的探讨早期连续性肾脏替代治疗（CRRT）联合血液灌流（HP）对急性重症胰腺炎（SAP）患者氧合指数的影响及其临床意义。方法将40例SAP患者随机分成A组、B组,每组20例,两组均给予常规治疗,B组在常规治疗的基础上接受CRRT＋HP治疗。观察两组患者治疗前后APACHEⅡ评分、氧合指数变化及急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）发生率、机械通气比率、呼吸机相关性肺炎（VAP）发生率及入住ICU时间。结果随治疗时间延长,两组患者氧合指数有逐步上升趋势,但B组患者氧合指数上升程度大于A组（P〈0.05）;两组APACHEⅡ评分随治疗时间延长而下降,B组APACHEⅡ评分下降程度大于A组（P〈0.05）。A组ALI/ARDS发生率为75.0%,机械通气比率为75.0%,VAP发生率为55.0%,均明显高于B组的40.0%、40.0%和10.0%（P〈0.05）;A组入住ICU时间为（17.7±4.2）d,明显长于B组的（13.0±4.4）d（P〈0.05）。结论在常规治疗的基础上早期应用CRRT联合HP治疗SAP患者能有效改善APACHEⅡ评分、氧合指数,并可降低ALI/ARDS、VAP发生率,缩短患者住ICU时间。

Early Continuous Renal Replacement Therapy Combined with Hemoperfusion Applied to Preventing Acute Lung Injury in Patients with Severe Acute Pancreatitis

Objective To explore the effect of early continuous renal replacement therapy（ CRRT） combined with hemoperfusion（ HP） on oxygenation index in patients with severe acute pancreatitis（ SAP） and its clinical significance.Methods Forty SAP patients were randomly divided into group A and group B,20 cases in each group. The two groups were given conventional treatment,group B was given CRRT plus HP therapy besides conventional treatment. The APACHEⅡ score,oxygenation index changes before and after treatment as well as the incidence of acute lung injury（ ALI） /acute respiratory distress syndrome（ ARDS）,rate of mechanical ventilation,incidence of ventilator associated pneumonia（ VAP）and ICU stay were observed in two groups. Results The oxygenation index increased gradually with the increasing treatment time in two groups,the increase of oxygenation index in group B was greater than that in group A（ P 〈 0. 05）. The APACHEⅡ score decreased with the increasing treatment time in two groups,the decrease of APACHEⅡ score in group B was greater than that in group A（ P 〈 0. 05）. The incidence of ALI /ARDS,rate of mechanical ventilation and VAP incidence in group A were higher than those in group A（ 75. 0% vs. 40. 0%,75. 0% vs. 40. 0%,55. 0% vs. 10. 0%,P 〈 0. 05）. The ICU stay in group A was（ 17. 70 ±4. 24） days,longer than that[（ 13. 0 ±4. 4） days]in group B（ P 〈 0. 05）. Conclusion Besides conventional treatment,early CRRT combined with HP can improve the APACHEⅡ score and oxygenation index,reduce the incidences of ALI /ARDS,VAP and ICU stay.