连续性血液净化治疗重症急性胰腺炎的临床分析

目的 探索连续性血液净化（CRRT）对重症急性胰腺炎（SAP）的治疗作用，提高重症急性胰腺炎的抢救成功率。方法 选择15例SAP患者给予CRRT治疗，观察治疗前、后患者血液生化指标、血常规、血气分析，并进行动态急性生理学及慢性健康状况评分（APACHEII）、简化急性生理学评分（SAPSII）和多脏器功能障碍综合征（MODS）评分。结果 与治疗前相比，CRRT治疗第2日晨和CRRT治疗结束后次日晨患者APACHEII、SAPSII和MODS评分比治疗前降低，治疗后氧合指数（PO2/FiO2）有明显改善。CRRT治疗次日晨PO2/FiO2和CRRT脱水量呈正相关；CRRT治疗第2日晨，脱水量与MODS评分呈负相关。CRRT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。结论 CRRT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，CRRT治疗时间似乎越长越好；但对BUN、Cr正常的患者，治疗时间可以缩短。连续性血液净化能改善、维持重症胰腺炎患者心、肺、肾、脑等重要脏器功能，提高其抢救成功率，对重症急性胰腺炎有较好的治疗作用。

Clinical analysis of treatment of severe acute pancreatitis with continuous blood purification

Objective To study the mechanisms of treating severe acute pancreatitis(SAP) with continuous blood purification(CRRT).Methods Fifteen SAP patients were chosen and treated with CRRT.Blood biochemical indexes,routine,gas analysis were tested pre-,intra-and post-treatment of CRRT.Meanwhile,APACHEII,SAPSII and MODS scores 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(FiO2/PO2) was improved obviously.The pressure-adjusted heart rate(PAHR) during the treatment was decreased.It was positive correlation with the amount of desideration by CRRT that the difference of the PO2/FiO2 and PAHR between the next morning pretreatment and intra-treatment.The amount of dehydration was negative correlation with MODS scores on the second morning during the treatment.BUN,Cr and uric acid were decreased during CRRT and the longer the time was,the lower the scores were.Conclusions The improvement of cardiac and pulmonary function is conceded with relieving interstitial edema of organization after dehydration by CRRT.However,it is not right that the more dehydration is,the better the patient is.The longer the time,the better the clearness of BUN and Cr.The time of CRRT should be shortened for the patients with normal BUN and Cr.