CVVHDF联合乌司他丁治疗慢性肾脏病并发急性胰腺炎疗效观察

摘要

目的 观察连续静脉静脉血液透析滤过(CVVHDF)联合乌司他丁治疗慢性肾脏病并发急性胰腺炎患者的临床效果.方法 30例慢性肾脏病并发急性胰腺炎患者随机分为3组,每组10例.A组:予以血液透析(HD)+常规治疗;B组:予以CVVHDF+常规治疗;C组:予以CVVHDF+乌司他丁+常规治疗.观察比较3组患者治疗后腹部体征改善情况、血尿淀粉酶、肝功能、白细胞计数、C反应蛋白、APACHE Ⅱ评分、低血压发生次数及心律失常发生次数.结果 治疗后3组患者血尿淀粉酶、白细胞计数、肝功能等指标均有改善.与A组相比,B组、C组患者腹部体征改善时间均明显缩短,低血压及心律失常发生次数明显减少.且B组、C组在第7天APACHE Ⅱ评分及第3天C反应蛋白均明显下降,而C组下降水平较B组更为明显.结论 CVVHDF具有血流动力学稳定及清除溶质更为彻底的优点,在慢性肾脏病合并急性胰腺炎患者的治疗中效果明显优于HD,且联合应用乌司他丁可以进一步改善患者全身炎症状态,进一步提高治疗效果.%Objective It is to observe the clinical effect of CVVHDF combined with ulinastatin on chronic kidney disease ( CKD ) complicating with acute pancreatitis. Methods Thirty patients of CKD complicating with acute pancreatitis were randomly divided into three groups: each group had 10 cases. Group A: HD therapy + conventional therapy; Group B: CVVHDF therapy + conventional therapy; Group C : CVVHDF therapy + ulinastatin + conventional therapy. The abdomen signs, the level of blood and urinary amylase, hepatic function, white blood cell count, C -reactive protein, APACHE II score and the frequency of occurrence of hypotension and arrhythmia in the three groups after treatment were compared. Results There were obvious improvements in the levels of blood and urinary amylase, hepatic function, white blood cell count in the three groups after treament. But compared group A, the course of treatment of abdomen signs was shorter and the frequency of occurrence of hypotension and arrhythmia were obviously reducing in group B and group C. The level of C - reactive protein and APACHE II score also obviously decreased in group B and group C, and the decrease extent was more obviously in group C. Conclusion Compared with HD, CVVHDF has more advantage in hemodynamics and solute clearance, and the curative effect is more better in the patients of CKD complicating with acute pancreatitis. Ulinastatin could further improve systemic inflammation condition in patient and increase the treatment effectiveness