早期持续性高容量血液滤过对重症急性胰腺炎急性肺损伤影响研究

目的研究早期持续性高容量血液滤过（HVHF）对重症急性胰腺炎（SAP）急性肺损伤（ALI）的影响。方法自2006年1月到2007年12月间，前瞻性随机将南京军区南京总医院普通外科研究所ICU 收治的59例入院时合并ALI/ARDS的SAP病人分为HVHF组和对照组，比较两组病人的氧合指数、ALI/ARDS的发生率、机械通气的例数及时间。结果（1）氧合指数：HVHF组入院第3、10天均较入院时明显改善（P<005），而对照组至入院第10天才较入院时有所改善（P<005）；并且在入院第3、10天，HVHF组均优于对照组病人（P<005）。（2）ALI、ARDS的发生率：HVHF组入院第10天较入院时明显降低（P<005）；对照组入院第10天较入院时降低不明显（P＞005）；入院第10天HVHF组均明显低于对照组（P<005）。（3）机械通气：两组病人急性期机械通气的例数差异无统计学意义（P＞005），但HVHF组机械通气时间明显较对照组缩短（P<005）。结论早期持续性HVHF治疗能有效促进合并ALI/ARDS的SAP病人肺功能的恢复，是一项重要的辅助治疗措施。

Effect of early continuous high-volume hemofiltration on severe acute pancreatitis with acute lung injury

Objective To investigate the effect of early continuous high-volume hemofiltration(HVHF) on lung function in patients with severe acute pancreatitis.Methods Based on the method of prospective,randomized and controlled clinical trial,55 patients suffered SAP with acute lung injury between January 2006 and December 2007 at Nanjing General Hospital of Nanjing Command of PLA were divided into control group and HVHF group.The oxygenation index,the morbility of ALI/ARDS and the case and time of mechanical ventilation(MV) between two groups were compared.Results(1)In HVHF group,the oxygenation indexes on the 3rd,10th day after admission were improved greater than those on the admission(P<0.05).Meanwhile,in control group,the oxygenation index only on the 10d after admission was improved greater than that on the admission(P<0.05).And the oxygenation indexes of 3d,10d after admission in HVHF group were improved greater than those in control group(P<0.05).(2) In HVHF group,the morbility of ALI/ARDS on the 10th day after admission was lower than that on the admission(P<0.05),but the same result was not seen in control group(P>0.05).And the morbility of ALI/ARDS on the 10d after admission in HVHF group was lower than that in control group(P<0.05).(3)There were no significant difference between the two groups of the patients treated with MV(P>0.05).But the duration time of MV in HVHF group was shorter than that in control group(P<0.05).Conclusion Early continuous high-volume hemofiltration can improve the function of lung in SAP,and is an important adjunctive therapy.