连续性肾脏替代疗法治疗重症急性胰腺炎合并急性肾损伤患者的临床分析

目的：观察连续性肾脏替代疗法（CRRT）治疗重症急性胰腺炎（SAP）合并急性肾损伤（AKI）患者的疗效及预后。方法：采用前瞻性临床对照研究方法,将24例SAP合并AKI患者随机分为常规治疗组（12例）和CRRT治疗组（常规治疗＋CRRT治疗组,12例）。治疗72h后对2组临床治疗效果进行比较（包括APACHEⅡ评分及其他主要临床指标）,同时观察0、6、12、24、48和72h各时间点患者血浆细胞因子TNF-α、IL-1、IL-6及IL-10浓度。结果：2组患者入组基线情况相似,但CRRT组患者存活率明显高于常规治疗组（75.0%vs58.3%,P〈0.05）。治疗72h后,CRRT组患者APACHEⅡ评分（16.7±5.8vs13.1±3.4,P〈0.05）、体温（38.0±1.3vs37.6±0.5,P〈0.05）、血清肌酐（149.9±34.7vs75.6±50.6,P〈0.05）和剩余碱（-4.83±4.06vs0.63±3.78,P〈0.05）较治疗前明显好转,而常规治疗组患者的变化并不显著。同时,CRRT组患者血浆TNF-α,IL-1,IL-10水平均显著下降（均P〈0.05）。结论：CRRT治疗能快速有效改善SAP患者病情,纠正体内酸碱紊乱、清除体内代谢毒素外,还能清除体内生成过多的促炎和抗炎细胞因子,疗效明显优于传统疗法,应在发生AKI之前即进行治疗。

Clinical Analysis of Continuous Renal Replacement Therapy in Patients With Severe Acute Pancreatitis Complicating Acute Kidney Injury

Objective：To evaluate the efficacy of continuous renal replacement therapy（CRRT）in patients with severe acute pancreatitis（SAP）complicating acute kidney injury（AKI）and its prognosis.Methods：Twenty-four patients with SAP complicating AKI were divided into routine treatment group（12 cases）and CRRT group（routine treatment ＋ CRRT,12 cases）.The clinical efficacy（APACHE Ⅱ score and other main clinical indexes）were compared between 2 groups 72 hours after treatment,meanwhile the blood samples were taken from those patients at 0,6,1 2,24,48 and 72 hours during CRRT to measure the levels of plasma TNF-α,IL-1,IL-6 and IL-10.Results：Patients of 2 groups were comparable at baseline.The survival rate was higher in patients with CRRT（75.0% vs 58.3%,P0.05）.APACHE Ⅱ score（16.7±5.8 vs 13.1±3.4;P0.05）,body temperature（38.0±1.3 vs 37.6±0.5;P0.05）,creatinine（149.9±34.7 vs 75.6±50.6;P0.05）,and base excess（-4.83±4.06 vs 0.63±3.78;P0.05）were improved significantly in patients with CRRT 72 hours after treatment.However,the improvement in patients of routine treatment group was not so obviously.At the same time,serum levels of TNF-α,IL-1,IL-10 were markedly decreased（P0.05）.Conclusions：CRRT can not only effectively improve the prognosis of patients with SAP complicating with AKI,ameliorate acid-base balance and remove metabolic waste,but also can decrease the production of cytokines.Its therapeutic effect is superior to traditional therapy,and should be initiated before occurence of kidney injury.