重症急性胰腺炎时CVVH的疗效及其对影像学的影响

目的 探讨连续性静脉-静脉血液滤过(CVVH)治疗重症急性胰腺炎(SAP)的效果及其对CT和MRI等影像学的影响。方法 对18例采用CVVH治疗的SAP患者的生命体征、氧合指标、血流动力学、CT或MRI影像、术中所见和预后等资料进行回顾性分析。结果 应用CVVH后，患者体温、脉搏下降，氧合指数(PaO2／FiO2)和肺泡-动脉氧差(AaDO2)得以改善，肺毛细血管楔压(PCWP)、体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)均有不同程度的改善，并能维持血流动力学的稳定，但在渡过急性反应期后，其CT或MRI影像的变化对手术时机判断的参考价值下降。结论 CVVH在重症急性胰腺炎早期治疗时可以显著缓解急性反应期的临床症状，但要结合临床感染征象评价影像学变化，从而正确掌握手术时机。

Effect of CVVH and its influence on medical image in patients with severe acute pancreatitis

Objective To explore the effect of continuous veno-venous hemofiltration (CVVH) and its influence on the image of CT or MRI in patients with severe acute pancreatitis(SAP).Methods Eighteen patients with severe acute pancreatitis were treated with CVVH.Their clinical data including vital signs,oxygenation parameter,haemodynamics,the image of CT or MRI,and manifestation in the operation and prognosis were analysed.Results All patients' temperature and pulse descented after the CVVH treatment,PaO 2/FiDO 2 and AaDO 2 were improved,PCWP,SVRI and PVRI were also improved to some extent.The steadiness of haemodynamics was maintainable.But after the acute reactive period,the value of image of CT or MRI on the selection of operative time was reduced.Conclusion The early CVVH treatment in patients with SAP could alleviate clinical sign obviously in acute reactive period.We must consider the patients' infectious signs when the image of CT or MRI to be assessed so that the correct operative time could be selected.