早期高容量血液滤过持续时间对重症急性胰腺炎急性肺损伤影响研究

目的 研究早期高容量血液滤过(HVHF)持续时间对重症急性胰腺炎(SAP)急性肺损伤(ALI)的影响.方法 将2006年8月到2009年4月怀化市第三人民医院ICU收治的49例入院时合并ALI急性呼吸窘迫综合征(ARDS)并在72 h内接受HVHF治疗的SAP患者随机分为两组.在常规治疗的基础上分别接受血滤持续时间8 h(Ⅰ组)和72 h(Ⅱ组)治疗.比较两组患者的APACHEⅡ评分、氧合指数、ALI/ARDS的改善率(包括治愈率)、机械通气的例数及时间、急性期并发症、HVHF相关并发症、结局及医疗费用等.结果 ①氧合指数及APACHEⅡ评分:两组入院第3天和第14天均较入院当天有所改善(P＜0.05).但在人院第3天和第14天,两组患者差异无统计学意义.②ALI、ARDS的改善率(包括治愈率):两组入院第3天和第14天较入院当天升高(P＜0.05);但在入院第3天和第14天.两组患者差异无统计学意义.③两组患者急性期机械通气的例数及时间、急性期并发症(多器官功能障碍综合征、急性肾功能衰竭、腹腔室隔综合征、导管相关感染、低血压)差异无统计学意义,但医疗费用差异有统计学意义(P＜0.05).两组患者急性期均无死亡.结论 发病72 h内的SAP早期短时(8 h)持续性HVHF治疗能有效促进合并ALI/ARDS的SAP患者肺功能的恢复,并且节约医疗费用.

Effect of duration in early high volume hemofiltration on severe acute pancreatitis with acute lung injury

Objective To investigate the effect of duration in high volume hemofiltration (HVHF)on lung function of patients with severe acute pancreatitis(SAP)in early stage.Methods Forty-nine patients who suffered from SAP with acute lung injury(ALI)/acute respiratory distress syndrome(ARDS)from Augest 2006 to April 2009 were randomly divided into group Ⅰ(HVHF for 8 hours)and group Ⅱ(HVHF for 72 hours).APACHE Ⅱ score,oxygenation index,the improvement rate(including cure rate)of ALI/ARDS,the ease and time of mechanical ventilation,complications in acute stage,complications related with HVHF,outcome,and medical cost of two groups were compared.Results ①The oxygenation index and APACHEⅡ of two groups on the 3rd.14th day after admission improved(P＜0.05).But there was no significant difference between two groups on the 3rd,14th day.②The improvement rate(including cure rate)of ALI/ARDS of two groups on the 3rd,14th day after admission was higher than that on the admission(P＜0.05).But there was no significant difference between two groups on the 3rd,14th day.③There was no significant difference in the case and time of mechanical ventilation,complications in acute stage(multiple organ dysfunction syndrome,acute renal failure,abdominal compartment syndrome,vessel infection,hypotension between two groups.But there was statistical significance in medical cost between two groups(P＜0.05). Conclusion Early continuous 8 hours HVHF can improve the function of lung in 72 hours of SAP onset,and save medical cost.