论文部分内容阅读
目的评价早期反复间断静脉-静脉血滤(RIVVH)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的价值。方法65例SAP患者随机分为RIVVH组(35例)和对照组(30例)。比较两组患者的生命体征、临床表现、血常规、肝肾功能、淀粉酶、脂肪酶、电解质、C-反应蛋白的变化、细菌培养阳性率、治疗前及治疗后的Balthazar CT评分、APACHEⅡ评分、开腹手术率、并发症发生率、病死率、治愈率、平均住院时间以及费用。结果RIVVH组35例中2例死于多器官衰竭,病死率5.7%,对照组死亡8例(26.7%),差异有统计学意义(P<0.05);RIVVH组治愈率94.3%(33/35),优于对照组的73.3%(22/30),P<0.05。RIVVH组治疗后患者的生命体征、腹部体征、血生化指标、氧合指数和C-反应蛋白均明显趋于改善,与对照组比较差异有统计学意义(P<0.05,P<0.001);RIVVH组Balthazar CT和APACHEⅡ评分较对照组显著降低(P<0.001);感染发生率也较对照组显著降低(P<0.001)。在缩短平均住院时间,降低平均住院费用、开腹手术率和并发症发生率RIVVH组明显优于对照组(P<0.05)。结论早期RIVVH治疗SAP有望成为SAP重要的辅助治疗措施。
Objective To evaluate the value of early intermittent venous-venous hemofiltration (RIVVH) in the treatment of severe acute pancreatitis (SAP). Methods 65 patients with SAP were randomly divided into RIVVH group (35 cases) and control group (30 cases). The changes of vital signs, clinical manifestations, blood tests, liver and kidney function, amylase, lipase, electrolytes and C-reactive protein, positive rate of bacterial culture, Balthazar CT score before and after treatment, APACHEⅡscore , Open surgery rate, complication rate, case fatality rate, cure rate, average length of stay, and cost. Results Two of the 35 patients in the RIVVH group died of multiple organ failure with a mortality rate of 5.7% and 8 patients (26.7%) in the control group, with a significant difference (P <0.05). The cure rate in RIVVH group was 94.3% (33/35) ), Better than the control group 73.3% (22/30), P <0.05. The vital signs, abdominal signs, blood biochemical indexes, oxygenation index and C-reactive protein in RIVVH group were significantly improved after treatment, which were significantly different from those in control group (P <0.05, P <0.001) Balthazar CT and APACHE Ⅱ scores were significantly lower than those of the control group (P <0.001). The incidence of infection was also significantly lower than that of the control group (P <0.001). The RIVVH group was significantly better than the control group (P <0.05) in shortening the average length of hospital stay, reducing the average cost of hospitalization, the rate of laparotomy and the incidence of complications. Conclusion Early treatment of RIVVH SAP is expected to become an important adjuvant SAP treatment.