联合血液滤过和腹膜透析治疗急性重症胰腺炎

目的研究联合血液滤过和腹膜透析治疗急性重症胰腺炎的治疗作用及其机理。方法将40例急性重症胰腺炎患者随机分为治疗组(25例)和对照组(15例)。治疗组在常规保守治疗基础上使用腹膜透析和血液滤过,连续治疗3d;对照组仅常规保守治疗。比较两组的腹痛、腹胀缓解时间、CT积分、APACHEⅡ积分以及住院时间、住院费用、转手术率、并发症发生率和治愈率。比较两组外周血、腹膜透析液中TNF、IL-6、IL-8三种细胞因子在治疗前后各时相点的含量。结果治疗组的腹痛、腹胀缓解时间、CT积分、APACHEⅡ积分、住院时间、住院费用均较对照组显著降低。治疗组三种细胞因子含量在治疗后第1天、第2天与治疗前以及对照组比较显著降低。结论联合运用腹膜透析和血液滤过治疗急性重症胰腺炎疗效明显,清除细胞因子明显;对于阻止胰腺局部病变和全身病情加重有显著作用,而且早期治疗疗效明显。

Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis

OBJECTIVE: To study the therapeutic effects and its mechanism of combination of hemofiltration (HF) and peritoneal dialysis (PD) in the treatment of severe acute pancreatitis (SAP). METHODS: Forty patients with SAP were divided at random into the HF + PD group (therapeutic group, 25 patients) and the non-HF + PD group (contrast group, 15 patients). Both groups were treated by the conventional mode of therapy.The release time of abdominal pain and distention, CT scores, APACHE II scores, the time of hospital stay, cost of treatment in hospital, operative rate and rate of complications and recovered rate of the two groups were compared. Simultaneously, the concentration of serum and fluid filtrated pro-inflammatory cytokines TNF, IL-6 and IL-8 were also determined pro and post the therapy. RESULTS: The time needed for the disappearance of abdominal pain and the amelioration of abdominal distension, CT scores, APACHE II scores, the average hospital stay and hospital cost of the therapeutic group were significantly decreased compared with those of the contrast group. The cytokines detected at the end of 1d, 2d after HF + PD were decreased significantly compared with those observed in pro HF + PD and the contrast group. CONCLUSIONS: The above results show that the cytokines overproduced during the development of SAP can be removed effectively from the circulation and the fluid filtrated by means of HF + PD. The continual deterioration of the local focus and systemtic presentation could be prevented effectively too, and the earlier the treatment of HF + PD, the better the prognosis.