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目的研究血浆置换(plasma exchange,PE)联合连续性静脉-静脉血液滤过(continuous venous-venous hemofiltration,CVVH)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效。方法30例重症急性胰腺炎患者除经内科常规治疗外,行PE联合连续性静脉-静脉血液滤过(CVVH)治疗,在治疗前、PE后、CVVH结束时,分别检测血淀粉酶、脂肪酶、血脂、C反应蛋白(C-reactive protein,CRP)及血肿瘤坏死因子a(tumor necrosis factor-alpha,TNF-a),并进行ICU监护的结果记录。以APACHE II评分及SIRS评分判断患者病情的变化[1]。在治疗过程中,血流动力学稳定,血浆置换后血淀粉酶、脂肪酶、血脂、血CRP、血TNF-a明显下降(P<0.05),CVVH治疗前与治疗后相比APACHE II评分及SIRS评分差异显著(P<0.05)。结论PE联合CVVH治疗可显著改善重症急性胰腺炎患者的临床症状,有效改善重症急性胰腺炎的预后。
Objective To study the efficacy of plasma exchange (PE) combined with continuous venous-venous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP). Methods Thirty patients with severe acute pancreatitis were treated with PE combined with continuous venovenous hemofiltration (CVVH) in addition to the routine medical treatment. Before treatment, after PE and CVVH, serum amylase, lipase , Blood lipids, C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-a) were detected and recorded. APACHE II score and SIRS score to determine the patient’s condition changes [1]. During the course of treatment, hemodynamics was stable, blood amylase, lipase, blood lipids, blood CRP and blood TNF-a were significantly decreased after plasma exchange (P <0.05). Compared with APACHE II score before and after CVVH treatment SIRS score difference was significant (P <0.05). Conclusion PE combined with CVVH treatment can significantly improve the clinical symptoms of patients with severe acute pancreatitis and effectively improve the prognosis of severe acute pancreatitis.