用持续血液净化治疗急性重症胰腺炎11例分析

目的探讨持续血液净化对急性重症胰腺炎的应用疗效。方法选择2004年11月～2007年8月急性重症胰腺炎患者11例．其中男性8例，女性3例，年龄27～49岁，平均年龄36．7岁；在常规治疗基础上，加用持续血液净化治疗．每次治疗24～48h后更换滤器，持续治疗3～10d，置换液以前稀释方式输入，流量为3000～6000ml／h，血流量200～300ml／min。采用普通肝素抗凝。结果11例患者中9例好转而转入普通病房继续治疗，1例因合并严重肺部感染并发多脏器功能衰竭死亡，1例因其他原因放弃治疗；治疗后患者平均动脉压（67．23±11．69）mmHg]、心率（85．61±14．36）次／分1和氧合指数（259．96±29．51）均有所改善（P〈0．05）；血淀粉酶（87．59±31．68）U/L]、脂肪酶（190．21±66．50）U/L]、血乳酸（1．69±0．82）mmol／L]和C-反应蛋白（39．33±10．17）mg/L]较治疗前（638．65±79．42）U/L、（734．79±86．91）U/L、（7．11±3．25）mmol/L、（141．21±33．63）mg／L]下降明显（P〈0．05），APACHEⅡ评分亦较治疗前降低（P〈0．05）。结论持续血液净化疗法对急性重症胰腺炎患者在治疗过程中血流动力学稳定．有改善愈后的作用．是抢救急性重症胰腺炎的有效手段之一．

Analysis of continuous blood purification in 11 patients with severe acute pancreatitis

Objective To study the treatment effect of continuous blood purification （CBP） on patients with severe acute pancreatitis （SAP）. Methods From November 2004 to Augest 2007,the continuous blood purification was performed in 11 patients （8 male,3 female and mean age 36.7 years） with severe acute pancreatitis. The CBP was performed continuously for 3 to 10 days. The filter was replaced between 24 and 48 hours. The uhrafihration rate during CBP was 3 000 - 6 000 ml/h and blood flow rate was 200 - 300 ml/min. Normal heparin was used as anticoagulant. Results Among 11 patients,9 patients relieved and one patient died from severe pulmonary infection with multiple organ failure,the else one patient had given up treatment. There were remarkable improvement in mean arterial blood pressure ,heart rate and oxygenation index（P 〈 0.05）. The serum amylase（87.59 ± 31.68） U/Lvs pre-treatment（638.65 ± 79.42） U/L],lipase（190.21 ＋ 66.50） U/Lvs pre-treatment（734.79± 86.91） U/L],lactic acid （ 1.69± 0.82） mmol/L vs pre-treatment （7.11± 3.25 ） mmol/L] and C-reactive protein （39.33 ± 10.17 ） mg/L vs pretreatment （ 141.21 ± 33.63） mg/L] were also declined （P 〈 0.05）, The scores of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） were declined,too （P 〈 0.05）. Conclusion The haemodynamic variables are stabilized during CBP and no obvious side-effects related to CBP is found, The therapy of continuous blood purification can improve the prognosis of the patients with severe acute pancreatitis.