早期连续性血液净化治疗重症急性胰腺炎14例

目的:探讨早期连续性血液净化(continuous blood purification,CBP)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的临床疗效.方法:选取符合SAP诊断且年龄18-65岁的住院患者,自愿行早期(起病48h内)CBP治疗的患者纳入试验组,其余患者纳入对照组.所有患者均按指征接受机械辅助呼吸、肠外营养、抗感染、血管活性药物、生长抑素、抗弥漫性血管内凝血等治疗.试验组病例在确诊SAP后8h内开始连续性血液净化治疗.比较2组患者在治疗前、治疗后1、3、5d的APACHEⅡ评分、血浆TNF-α检测值逐渐变化的差异性.在同一组患者中,比较相邻2d的APACHEⅡ评分值的差异性.结果:试验组病例在CBP治疗后,患者症状体征明显改善,治疗后1、3、5d APACHEⅡ评分、血浆TNF-α检测值与对照组比较,差异有显著性意义(APACHEⅡ评分:15.93±4.81vs18.50±4.77,13.71±4.01vs18.08±4.83,10.79±2.39vs15.17±4.59;TNF-α:60.00±15.27vs89.08±25.56,42.14±6.94vs89.83±23.19,39.00±6.04vs80.00±23.02,均P<0.05);试验组病例治疗后1、3、5d APACHEⅡ评分、血浆TNF-α检测值较治疗前显著下降,差异有显著性(P<0.05).结论:早期CBP治疗可显著改善SAP患者的临床症状,保护器官功能,改善预后,降低病死率.

Early continuous blood purification for treatment of severe acute pancreatitis:an analysis of 14 cases

AIM:To evaluate the clinical efficacy of early continuous blood purification(CBP) in patients with severe acute pancreatitis(SAP).METHODS:Fourteen patients who were diagnosed with SAP and were willing to undergo early(within 48 h after onset) CBP were included in test group,while 12 SAP patients were included in control group.All patients received mechanical ventilation,parenteral nutrition,antibiotics,vasoactive drugs,somatostatin,or antidisseminated intravascular coagulation treatment according to indications.The test group began to receive CBP within 8 hours after the diagnosis of SAP.APACHE II score and plasma TNF-α levels were compared before treatment and 1,3,5 days after treatment between the two groups.RESULTS:Early CBP significantly improved the signs and symptoms of SAP.On days 1,3 and 5,APACHE II score and plasma TNF-α levels differed significantly between the control group and the test group(APACHE II score:15.93 ± 4.81 vs 18.50 ± 4.77,13.71 ± 4.01 vs 18.08 ± 4.83,10.79 ± 2.39 vs 15.17 ± 4.59;TNF-α:60.00 ± 15.27 vs 89.08 ± 25.56,42.14 ± 6.94 vs 89.83 ± 23.19,39.00 ± 6.04 vs 80.00 ± 23.02,all P < 0.05).APACHE II score and plasma TNF-α levels decreased significantly in the test group on days 1,3 and 5 compared to before treatment(all P < 0.05).CONCLUSION:Early CBP can significantly improve clinical symptoms,protect organ function,improve prognosis,and reduce mortality in SAP patients.