连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值

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。

Continuous veno-venous hemofiltration in treatment of severe acute pancreatitis

OBJECTIVE: To observe the efficacy of continuous veno-venous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP). METHODS: Fifty three patients with SAP were involved, CVVH was performed for at least 24 hours. During CVVH, the patients' conditions and pancreatic enzymes (amylase and lipase) were observed, serum concentration of endotoxin was measured as well. RESULTS: After CVVH, the symptoms of patients such as tachycardia, respiratory distress, and abdominal pain were remitted. The APACHE II score decreased significantly. Six hours after CVVH, serum concentration of endotoxin was decreased significantly. Fifteen patients died, the mortality rate was 28.3%. CONCLUSION: CVVH could decrease the mortality rate of SAP with multiple organ dysfunction syndrome.