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目的:探讨连续性高容量血液滤过(2HVHF)治疗重症急性胰腺炎(SAP)的临床疗效,评价其在基层医院SAP治疗中的作用。方法:将2010年11月-2013年9月我院ICU收治的SAP患者39例随机分为研究组19例和对照组20例,前者予常规治疗+CHVHF治疗,后者仅予常规治疗。比较两组治疗前、治疗后3 d、7 d的体温、呼吸、心率、平均动脉压、急性生理与慢性健康(APACHEⅡ)评分及白细胞计数、血清淀粉酶、丙氨酸转氨酶、血肌酐的动态变化。结果:两组在治疗过程中的体温、呼吸、心率及平均动脉压、APACHEⅡ评分、白细胞计数、血清淀粉酶均逐步改善,但研究组较对照组的改善更明显(P<0.05),研究组治疗后第7d的血肌酐明显低于对照组(P<0.05),而两组的丙氨酸转氨酶变化无明显差异;研究组的死亡率显著低于对照组(15.8%vs45%,P<0.05)。结论:CHVHF治疗能改善SAP患者的临床症状及实验室指标,降低死亡率,可作为SAP患者常规治疗外的辅助治疗。
Objective: To investigate the clinical efficacy of continuous high-volume hemofiltration (2HVHF) in the treatment of severe acute pancreatitis (SAP) and to evaluate its role in the treatment of SAP in primary hospitals. Methods: From November 2010 to September 2013, 39 patients with SAP in our hospital were randomly divided into study group (n = 19) and control group (n = 20). The former was treated with conventional therapy and CHVHF, the latter with conventional therapy only. The changes of body temperature, respiration, heart rate, mean arterial pressure, acute physiology and chronic health (APACHEⅡ) scores, white blood cell count, serum amylase, alanine aminotransferase and serum creatinine were compared between the two groups before and 3 and 7 days after treatment Variety. Results: The body temperature, respiration, heart rate and mean arterial pressure, APACHEⅡscore, white blood cell count and serum amylase in the two groups were all improved gradually. However, the improvement of the study group was more obvious than that of the control group (P <0.05) Serum creatinine was significantly lower on the 7th day after treatment than the control group (P <0.05), while there was no significant difference in ALT between the two groups. The mortality in the study group was significantly lower than that in the control group (15.8% vs 45%, P <0.05 ). Conclusion: CHVHF treatment can improve the clinical symptoms and laboratory indexes of SAP patients and reduce the mortality rate, which can be used as an adjuvant therapy in patients with SAP.