连续性静脉-静脉血液滤过治疗中、重度急性胰腺炎的临床研究

摘要

目的：探讨CVVH模式治疗中/重度急性胰腺炎（MSAP/SAP）的临床疗效。方法在2011年01月至2013年12月汉中市3201医院收治的MSAP/SAP患者共82例样本进行回顾性分析。其中有43例在常规非手术治疗的基础上采用CVVH治疗，另外39例未采用CVVH治疗作为对照组。分别观察两组患者入院时及治疗72 h后各类血液生化指标的变化、APACHE-Ⅱ评分，比较两组患者住院时间、存活率、胰腺坏死发生率以及SAP发生率的差异。其中测量数据资料比较采用独立样本t检验，发生率比较采用χ2检验，并采用重复测量数据方差分析生成线图，以直观地反映疗效差异，以P＜0.05为差异有统计学意义。结果两组患者的年龄、以及入院时所测的APACHE-Ⅱ评分、年龄、多项重要生化指标比较无统计学差异（P＞0.05）。治疗72 h后CVVH治疗组的临床症状较对照组改善明显，复测APACHE-Ⅱ评分、ALT、AST、BUN、UA、TG、CRP等指标均下降明显，其差异有统计学意义（P＜0.05）；两组患者住院时间的差异有统计学意义；患者存活率、SAP发生率、IAH发生率及胰腺坏死率的差异有统计学意义（P＜0.05）。结论治疗MSAP/SAP在常规综合治疗的基础上及时采用CVVH治疗，可在发病早期有效清除血液中的炎性介质及内毒素，对人体内环境的稳定、早期细胞组织氧合作用的改善以及拮抗器官的功能衰竭有积极作用，可有效改善预后，阻止部分MSAP进展为SAP，减少并发症的发生，降低住院天数。%Objective To investigate the clinical efficacy of CVVH mode in the treatment of moderate/severe acute pancreatitis(MSAP/SAP).Methods In the MSAP/SAP patients of 3201 Hospitals of Hanzhong City from January 2011 to December 2013 , a total of 82 cases of samples were retrospectively analyzed.There are 43 cases in which the use of CVVH treatment based on conventional non-surgical therapy, another 39 patients without the use of CVVH treatment as a control group .To observe the changes of various types of blood biochemical parameters , APACHE-Ⅱ score after 72 hours’ treatment of the two groups of patients respectively. To compare the difference of hospitalization , survival , incidence rate of pancreatic necrosis and SAP between the two groups of patients, which the measurement data were compared in the using of independent samples t test , and the incidence rate were compared in the using of x2 test, and using repeated measurement data of variance analysis to generate charts, to reflect the difference of efficacy visually, andP<0.05 was considered statistically significant.Results The age and measured admission APACHE-Ⅱ score , age, numbers of important biochemical markers of both groups were no significant difference(P>0.05). After 72 hours’ treatment, the clinical symptoms of CVVH treatment group compared with the control group improved significantly, and the retest APACHE-Ⅱ score, ALT, AST, BUN, UA, TG, CRP and other indicators are significantly decreased, in which the difference was statistically significant(P<0.05).The difference of hospitalization between the two groups were statistically significant.The difference of patient survival, incidence rate of SAP, IAH and pancreatic necrosis was statistically significant(P<0.05).Conclusion In the treatment of MSAP/SAP on the basis of routine treatment on the timely adoption of CVVH treatment can effectively remove the inflammatory mediators and endotoxin in the blood in the early onset, which can keep a stable environment for the human body ,can improve the failure of early tissue oxygenation and antagonistic organ with a positive effect , can effectively improve outcomes, prevent some MSAP progress to SAP, to reduce the incidence of complications, and to reduce the number of days of hospitalization.