血液吸附联合连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效观察

摘要

Objective To investigate the therapeutic effects of early continuous veno-venous hemofiltration (CVVH)and hemoperfusion(HP)on patients with severe acute pancreatitis (SAP). Methods 22 patients with SAP were treatment with conventional methods and CVVH+HP for 72 hours at least. The kidney function, urine volume and APACHE Ⅱ were observed. Results 22 patients with fever, tachycardia, shortness of breath were all relieved. 4 patients die of multi-organ function failure. 1 patient died of fungal sepsis. 1 patient died of acute respiratory distress syndrome. 2 patients give up treatment because of the economic reason. The survival rate of 63. 6％. Conclusion It is obvious that SAP merging with AKI can help patients on early kidney function restoration, improve clinic symptoms, and raise survival rate.%目的 探讨血液吸附联合连续性血液净化治疗重症急性胰腺炎(SAP)合并急性肾损伤(AKI)的疗效.方法 对22例重症急性胰腺炎合并急性肾损伤的患者,先给予内科治疗,在循环相对稳定后尽早(平均3.2±1.5天)给予血液吸附(HP)联合连续性静-静脉血液滤过(CVVH).CVVH至少连续行72h后改为每天行8h,直至进入多尿期.22例患者行CWH的时间72～232(平均120±26)h.HP每次2h,每隔24h治疗一次,共治疗5次,观察与比较治疗前后患者肾功能,小便量以及临床症状、体征、生化指标、APACHE Ⅱ评分的变化.结果 22例患者早期发热、心动过速、呼吸急促、等症状均得到明显缓解.4例患者死于多器官功能衰竭,1例死于真菌性败血症,1例死于急性呼吸窘迫综合征,2名患者因经济原因放弃治疗,余14例患者好转转普通病房.ICU存活率63.6%.结论 SAP合并AKI患者行CVVH联合HP能明显有益于患者肾功能的早期恢复,改善临床症状,提高患者的存活率,已成为SAP治疗中的重要措施之一.