血液滤过治疗重症急性胰腺炎的前瞻性临床研究

目的 前瞻性研究血液滤过治疗重症急性胰腺炎的临床效果.方法 遵循随机对照的实验方法,将哈尔滨医科大学第一临床医学院2004年1月至2007年8月治疗的重症急性胰腺炎37例,按发病72 h内是否接受血液滤过分为实验组(血液滤过组,n=17)与对照组(非血液滤过组,n=20),比较两组病人的APACHEⅡ评分、呼吸功能和血流动力学状态、血浆细胞因子等指标.结果 实验组病人的APACHEⅡ评分、血流动力学指标、呼吸功能、血浆细胞因子在血液滤过6 h后明显改善(P<0.05);与对照组比较有统计学意义(P<0.05);72 h后两组间差距缩小;7 d后组间监测指标比较无统计学意义;实验组和对照组病人的平均住院时间[(23.7±4.7)dvs(30.5±6.0)d]、中转手术率(17.6%vs 35.0%)和病死率(5.9%vs 15%)比较有统计学意义(P<0.05).结论 重症急性胰腺炎早期进行血液滤过可以有效改善临床症状,预防全身炎症反应综合征和多器官功能障碍综合征,缩短平均住院时间,降低中转手术率和病死率.

Therapeutic effect of hemofiltration on severe acute pancreatitis: a prospective clinical study

Objective To investigate the therapeutic effect of hemofiltration on severe acute pancreatitis(SAP) prospectively. Methods In this randomized controlled trail (RCT), 37 patients with AP treated in our hospital from January 2004 to August 2007 were divided into the treatment group (hemofiltration group, n=17)and control group (non-hemofiltration group, n=20). The pa-tients of treatment group were treated with hemofiltration within 72 h after onset. Detection included APACHEII scores, symptoms of respiration and haemodynamics, plasma concentrations of cytokine.Results Treatment group had several significant advantages over control group as early as 6 h after being treated with hemofihration, including better respiratory function and haemodynamic stability,lower APACHE Ⅱ scores and plasma concentrations of cytokine (P<0.05). Those advantages be-came small after 72 h and disappeared after 7 d. The duration of stay, rate of transferred surgery and mortality of treatment group vs those of control group were: (23.7±4.7) d vs (30.5±6.0) d,17.6±vs 35.0 %, 5.9±vs 15 %, respectively (P<0.05). Conclusion Hemofiltrstion can be used to improve clinical therapeutic effect of SAP, prevent systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) during the early stage and decrease the duration of stay, rate of transferred surgery and mortality.