连续性肾脏替代治疗在重症急性胰腺炎并发多器官功能障碍综合征中的应用

目的 观察连续性肾脏替代治疗(CRRT)在重症急性胰腺炎(SAP)并发多器官功能障碍综合征(MODS)治疗中的作用。方法 6例SAP并发MODS患者,除禁食、胃肠减压、腹腔灌洗、抗感染、抑制胰腺外分泌、肠外营养等治疗外,早期(1—3天)采用CRRT治疗。结果 抢救成功率为83％(5/6)。3例7天完全康复出院,2例分别于13天和21天康复出院。CRRT治疗后,血压回升,心率下降,心电图ST段恢复;缺氧明显改善,血氧饱和度和血氧分压均明显上升,1例患者于CRRT治疗3天后脱离机械通气;高钾血症、低钠血症、代谢性酸中毒迅速纠正,并始终保持电解质和酸碱平衡。腹痛明显减轻;尿量和血肌酐恢复正常;同时保证了肠外营养和其他治疗的实施。结论 CRRT早期应用于治疗SAP并发MODS的疗效肯定,可显著改善病情,缩短病程,提高抢救成功率。

The effect of continuous renal replacement therapy on patients with severe acute pancreatitis complicated with multiple organ dysfunctions

Objective To observe the effects of CRRT on patients with serve acute pancreatitis( SAP) complicated with multiple organ dysfunctions (MODS) . Methods 6 patients with SAP complicated with MODS underwent CRRT in the early stage(1 - 3 days) besides fasting, gastrointestinal decompression, peritoneal irrigation, antibiotics, block excretion of pancreas and parenteral nutrition. Results The survival rate raise. 5 of 6 patients survived and 1 died. The survival rate was 83 % . The duration and hospitalization - days shortened. 3 patients rehabilitated and discharged after 7 days and so did 2 after 13 and 21 days, respectively. The stability of cardiovascular improved. Blood pressure became stable, heart rate descented and ST depression reversed after CRRT. Hypoxia ameliorated strikingly. The SaO2 and PaO2 rised significantly after 6 - 24 hours of CRRT. 1 patient discontinue mechanical ventilatory support after 3 days of CRRT. The stability of interal environment was indeed assured. All patients had some types of disorder of electrolure and acid - base balance such as hyperkalemia, hyponatremia and metabolic acidosis, which were redressed after CRRT. Electrolure and acid - base balance was maintained during CRRT. Abdominalgia relieved in all patients after CRRT. Urine volume didn't reduce significantly. Half of these patients had their urine volume reduced and serum creatinine increased before CRRT, but both resumed after CRRT. The volume of infused fluid needn' t be restricted during CRRT. Parenteral nutrition and other therapy could be assured. Conclusion CRRT in the early stage is an effective therapeutic option for patients with serve acute pancreatitis complicated by multiple organ dysfunctions, after which patients' condition ameliorates, duration of disease shortens and survival rate increases.