摘要
①目的观察在传统方法治疗重症急性胰腺炎(SAP)的同时行连续性血液净化(CBP)的疗效.②方法 2002～2004年23例SAP病人在接受传统治疗的同时行CBP,采用连续性静脉-静脉血液滤过(CVVH)模式,滤器为AN69膜,面积0.9 m2,均以前稀释法输入置换液,流速为2 500～4 000 mL/h,血液体积流量130～180 mL/min,所有病人均72 h连续血滤.采用普通肝素抗凝.监测CBP前后病人症状体征及血清生化指标的变化,行动脉血气分析和APACHEⅡ评分,测血中内毒素水平.③结果 CBP治疗后病人发热、心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解;APACHEⅡ评分明显降低(t=3.27,P<0.01);血清胆红素(TB)、天冬氨酸转氨酶(AST)、淀粉酶(AMS)、尿素氮(BUN)、肌酐(Scr)明显降低(TB、AST、AMS:t=2.33～2.67,P＜0.05;BUN、Scr:t=3.48、3.57,P＜0.01);酸中毒、低氧血症纠正(HCO-3:t=-2.65,P＜0.05;PaO2:t=-5.47,P＜0.01).CBP治疗4 h后,血中内毒素水平下降,24 h后又恢复至治疗前的水平.23例病人中17例痊愈出院,存活率为73.9%.④结论在传统方法治疗SAP的同时行CBP,能有效救治临床并发症,降低病死率.
Objective To observe the effect of continuous blood purification（CBP） on the treatment of severe acute pancreatitis（SAP）. Methods Nineteen SAP patients underwent CBP from 2002 to 2004. Continuous veno-venous hemofittration （CVVH） was performed. Hemofilter was AN69（0.9m^2）. The ultrafiltration rate during CVVH was 2500-4000 mL/h, blood flow rate was 130-180 mL/min, and the substitute fluid infused with pre-dilution. Normal heparin was used as anticoagulant. All the patients underwent continuous CVVH for 72 h. Their general conditions, liver and kidney functions, arterial blood gas, A-PACHE Ⅱ score and serum concentration of endotoxin were observed. Results After CBP, the clinical symptoms such as fever, tachycardia, respiratory distress, abdominal pain and distention remitted. The APACHE Ⅱ score decreased significantly （t= 3.27, P〈0.01）, the level of serum total bilirubin（TB）, aspartate aminotransferase（AST）, amylas（AMS）, blood urea nitrogen（BUN）, and serum creatinine（Scr） notably decreased （t = 2. 33 - 3. 57 ; P 〈 0. 05,0. 01 ）. Acidosis and hypoxemia were corrected （t = -5.47, -2.65 ; P〈0.05,0.01 ）. Four hours after CBP treatment, serum concentration of endotoxin decreased significantly, but returned to the previous level after 24 h. Seventeen patients survived, with the survival rate of 73.9%. Conclusion CBP by combination of traditional therapy for SAP may effectively decrease complications and mortality of disease.
出处
《青岛大学医学院学报》
CAS
2005年第4期310-312,共3页
Acta Academiae Medicinae Qingdao Universitatis
