CRRT治疗重症急性胰腺炎的临床分析

目的 观察连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）治疗重症急性胰腺炎的临床疗效.方法 观察82例重症急性胰腺炎患者行床旁连续性静静脉血液滤过（continuous veno-venous hemofiltration,CVVHF）,监测治疗前后患者病情及血清生化指标和APACHEⅢ积分.并根据置换液流量分为：A组（30～45ml/（h·kg）及B组（45～60ml/（h· kg）,观察2组患者治疗24h后呼吸循环功能的改善.结果 治疗后患者生命征逐渐平稳、腹痛、腹胀明显缓解,血清淀粉酶（AMS）、三酰甘油（TG）、丙氨酰转移酶（GPT）、总胆红素（TB）、C反应蛋白（CRP）、血肌酐（Scr）、尿淀粉酶（AMS）均明显降低（P＜0.05）,低氧血症纠正（P＜0.05）,APACHEⅢ评分由治疗前（96.1±33.5）降至（48.9±13.7）,差异有统计学差异（P＜0.05）,82例患者65例痊愈,存活率79.3％.B组治疗24h后对呼吸和心率的改善较A组明显（P＜0.05）.结论 CRRT治疗急性重症胰腺炎疗效确切,能显著改善临床症状及预后.高流量组较低流量组更有利于早期改善呼吸循环功能.

The clinical analyses of the continuous renal replacement therapy on patients with severe acute pancreatitis

Objective To observe the outcome of patients with severe acute pancreatitis （SAP） treated with continuous renal replacement therapy （CRRT）.Methods Eighty-two hospitalized patients with SAP were treated with continuous veno-venous hemofiltration （CVVHF）.Biochemical parameters and APACHE Ⅲ score were examined before and after CVVHF.The patients were divided based on the replacement rate in CRRT into 2 groups,group A [30～45ml/（kg · h） and group B [45～60ml/（kg · h）].Respiratory rate and heart rate were recorded before CRRT and after CRRT for 24h.Results After CRRT,serum amylase,triglyceride,total bilirubin,C-reactive protein,creatinine,urine amylase decreased significantly （P〈0.05）,and hypoxemia improved （P〈0.05）.APACHE Ⅲ score decreased from 96.1±33.5 before CRRT to 48.9±13.7 after CRRT for 24h （P〈0.05）.Sixty-five of the 82 SAP patients recovered with the survival rate of 79.3%.Respiration rate and heart rate improved better in group B than in group A （P〈0.05）.Conclusions CRRT is effective for the treatment of SAP patients.It significantly improves the clinical symptoms and reduces the mortality of SAP.CRRT with higher replacement rate may be beneficial to stabilize respiration and circulation systems.