高通量血液滤过治疗急性重症胰腺炎合并急性肾功能衰竭的临床研究

目的探讨高通量血液滤过治疗(HVHF)在急性重症胰腺炎合并急性肾功能衰竭患者中的应用及对血浆白细胞介素(IL)-6浓度水平的影响。方法应用HVHF治疗急性重症胰腺炎合并急性肾功能衰竭患者15例,检测患者治疗前后血生化、血常规、C反应蛋白(CRP)及血pH值等指标的变化。首次HVHF治疗前、治疗2、6h、第2天治疗后、第3天治疗后留取肝素抗凝血3mL,用酶联免疫吸附试验(ELISA)法检测血浆IL-6浓度。结果HVHF治疗后患者血肌酐和尿素氮等指标较治疗前显著下降(P<0.01),电解质紊乱和代谢性酸中毒得到明显纠正(P<0.05),CRP明显降低(P<0.05)。治疗后6h及第2天血浆IL-6浓度水平较治疗前显著降低(P<0.05)。治疗后15例患者中11例存活,存活率为73%。结论HVHF具有较好的清除能力,能有效纠正急性重症胰腺炎合并急性肾功能衰竭患者水、电解质及酸碱平衡紊乱,消除炎性反应物质,可显著改善病情,纠正受累的脏器功能障碍,防止脏器损害的进一步发展,改善预后,提高抢救成功率。

Study of high volume hemofiltration on patients with severe acute pancreatitis combined acute renal failure

Objective To investigate the efficacy of high volume hemofihration on patients with severe acute pancreatitis combined acute renal failure, and its effect on plasma flammatory cytokines concentrations. Methods Fifteen patients with severe acute panereatitis combined acute renal failure were treated by high volume hemofihration （HVHF） for five days. The blood biochemical test, blood routine, CRP and blood pH were test before and after treatment. Blood samples were taken from the patients at 0, 2, 6 h, 2nd day and 3rd day during HVHF. The plasma IL-6 level were tested by ELISA. Results After treatment, the serum Ser, BUN, CRP concentration were significantly lower than before treatment （P〈0.01）, the metabolism state were improved （P〈0.05）, the plasma level of IL-6 at 6, 12h and 3rd day during HVHF were significantly lower than those before treatment （P〈0.05）. Eleven patients of 15 patients survived and the survival rate was 73%. Conclusion HVHF have better ability of clearance, which can efficiently improve the water- electrolyte disturbance, keep the acid-base balance, clear the inflammatory mediator and protect organs from further injuring, improve the patients＇condition and increase the survival rate.