EST、ENBD联合持续血液滤过治疗重度急性胰腺炎的临床分析

摘要

Objective To investigate the efficacy and significance of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)combined with the continuous blood purification(CBP)in the treatment of severe acute pancreatitis(SAP).Meth-ods The clinical data of 179 patients with SAP treated in our hospital over a period of ten years were retrospectively analyzed.The cases were divided into four groups according to the treatment methods.The conventional group was treated with the routine meth-od,the CBP group received the CBP therapy combibed with routine methods,the endoscopic group was given EST and ENBD on the basis of the routine methods and the combined group was treated with CBP,EST and ENBD.The patients′vital signs,WBC,CRP, APACHE Ⅱ score,abdominal signs change,incidence of complications,mortality and hospitalization days were compared among 4 groups.Results Compared with the conventional group,the clinical indicators,WBC,CRP,APACHEⅡ scores,blood amylase lev-el,incidence of local complications,mortality and hospitalization days in the rest three groups were decreased significantly(P<0.05),the total effective rate of abdominal signs relief was significantly increased(P<0.05);compared with the rest groups,the to-tal effective rate of abdominal signs relief in the combined group was increased(P<0.05),the blood amylase level,incidence of local complications and hospitalization days were decreased significantly(P<0.05),the mortality was significantly lower than that in the conventional group(P<0.05),however there was no difference between the CBP group and the endoscopic group(P>0.05).Con-clusion CBP combined with EST and ENBD in treating SAP has the active and effective role for improving the disease condition, reducing complications and the mortality,and shortening the hospitalization time.%目的：探讨内镜下十二指肠乳头括约肌切开术（EST）、经内镜鼻胆管引流术（ENBD）联合持续血液滤过在重度急性胰腺炎（SAP）治疗中的效果和意义。方法回顾性分析近10余年该院收治的179例 SAP患者的临床资料，根据其治疗方式分为4组，常规组给予内科常规治疗，连续血液净化（CBP）组在常规治疗的基础上行血液滤过，内镜组在常规治疗的基础上行 EST、ENBD治疗，联合组行持续血液滤过和 EST、ENBD。对比4组患者生命体征、白细胞、C反应蛋白、APACHEⅡ评分、腹部体征变化情况、并发症发生率、病死率及住院天数。结果与常规组比较，其余3组治疗后各临床指标、APACHEⅡ评分、血淀粉酶水平、局部并发症发生率、病死率及住院天数明显下降（P＜0．05），腹部体征缓解的总有效率明显增高（P＜0．05）；与其他3组比较，联合组血淀粉酶水平、局部并发症发生率及住院天数明显降低（P＜0．05）；腹部体征缓解总有效率明显增高（P＜0．05），病死率联合组明显低于常规组（P＜0．05），但与CBP组、内镜组比较差异无统计学意义（P＞0．05）。结论持续血液滤过联合 EST、ENBD治疗 SAP能有效改善患者病情，对于减少并发症、降低病死率及缩短住院时间有积极有效的作用。