持续血液滤过治疗高脂血症性急性胰腺炎24例

目的:观察早期连续血液滤过(continuous veno-venous hemofiltration,CVVH)对高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLP)的治疗效果.方法:49例HLP患者随机分为2组:连续血液滤过组(A组,n=24)和对照组(B组,n=25).在常规治疗的基础上,A组加用连续血液滤过.观察治疗前后两组患者的心率(HR)、呼吸(R)、氧合指数(PO2/FiO2)、血氧饱和度(SaO2)、血清甘油三酯(TG)、白介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)等指标的变化;并行APACHE~ 动态评分;比较两组治疗前后急性并发症的变化及治愈率.结果:经CVVH治疗后72h,患者临床症状改善明显,HR、R降至正常,APACHE~评分下降明显(10.8±5.1vs15.5±6.9,P<0.05);血清TG、IL-6及TNF-α亦明显下降(6.8±3.7vs18.5±6.3,39.8±16.7vs72.4±25.1,37.5±14.1vs61.2±16.1,P<0.05).治疗7d后,两组休克均获纠正(P<0.05).A组ARDS和急性肾功能障碍控制迅速,发生率下降明显(5.0%vs37.5%,5.0%vs25%,P<0.05).A组治愈22例,死亡2例,死亡率8.3%;B组治愈20例,死亡5例,死亡率20%,治疗效果显著.结论:CVVH治疗HLP有明显的效果,能有效改善患者病情,降低病死率.

Treatment of hyperlipidemic acute pancreatitis by continuous venovenous hemof iltration:an analysis of 24 cases

AIM:To observe the treatment effect of continuous veno-venous hemofiltration(CVVH) in patients with hyperlipidemic acute pancreatitis(HLP).METHODS:Forty-nine HLP patients were randomly divided into two groups:CVVH group(A,n = 24) and control group(B,n = 25).Both groups underwent conventional therapy,and patients in group A additionally underwent CVVH.Heart rate(HR),respiration,PO2/FiO2,SaO2,triglyceride(TG),IL-6 and TNF-α were monitored.APACHE score was used to evaluate patients’ condition.The incidences of acute complications and survival rate were compared between the two groups.RESULTS:After treatment by CVVH,HR,respiration,APACHE(10.8 ± 5.1 vs 15.5 ± 6.9,P< 0.05) as well as serum levels of TG,IL-6 and TNF-α(6.8 ± 3.7 vs 18.5 ± 6.3,39.8 ± 16.7 vs 72.4 ± 25.1,37.5 ± 14.1 vs 61.2 ± 16.1,all P < 0.05) decreased signif icantly.Seven days later,shock was corrected in both groups(P < 0.05).In group A,the incidences of acute renal failure(ARF) and acute respiratory distress syndrome(ARDS) were significantly decreased(5.0% vs 37.5%,5.0% vs 25%,both P < 0.05).Compared to group B,group A had a higher survival rate(8.3% vs 20%).CONCLUSION:CVVH is effective in treating HLP and is associated with a lower case fatality rate.