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目的:探讨连续肾脏替代疗法(CRRT)治疗重症急性胰腺炎的最佳时机。方法:选取我院收治的30例重症急性胰腺炎(SAP)患者为研究对象,按发病后行CRRT的时间分将患者随机为A、B两组,A组发病后72小时内治疗,B组发病后72小时后治疗,分析和比较两组治疗后的临床转归及生命体征变化、APACHEⅡ评分变化急性生理与慢性健康状况、住院费用、平均住院时间。结果:经CRRT治疗后,A组死亡率(14.3%)低于B组(43.7%),差异有统计学意义(P<0.05);A、B两组治疗后体温、心率、呼吸、平均动脉压平稳,A组优于B组,差异有统计学意义(P<0.05);A组的平均住院时间(15.7±8.9)d、住院费用(107000±65000)万元均明显优于B组,差异有统计学意义(P<0.05);两组患者治疗后APACHEⅡ评分均明显优于治疗前,治疗后A组APACHEⅡ评分明显优于B组,差异显著有统计学意义(P<0.05)。结论:早期行CRRT能明显改善重症急性胰腺炎患者的疗效和预后,最佳治疗时机可能为发病后72小时内。
Objective: To investigate the best timing of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis. Methods: Thirty patients with severe acute pancreatitis (SAP) admitted to our hospital were enrolled in this study. Patients were randomly divided into A and B groups according to the time of onset of CRRT. The patients in group A were treated within 72 hours after onset of disease. After 72 hours after onset, the clinical outcomes and the changes of vital signs after treatment were analyzed and compared. The changes of APACHEⅡscore in acute physiology and chronic health status, hospitalization cost and average hospitalization time were analyzed and compared. Results: After CRRT treatment, the death rate in group A was lower than that in group B (43.7%) (P <0.05). The body temperature, heart rate, respiration, mean arterial pressure (P <0.05). The mean length of hospital stay (15.7 ± 8.9) days and hospitalization cost (107,000 ± 65,000) in group A were significantly better than those in group B, (P <0.05). The APACHEⅡscores of both groups were significantly better than those before treatment. After treatment, APACHEⅡscore in group A was significantly better than that in group B, the difference was statistically significant (P0.05). Conclusion: Early CRRT can significantly improve the efficacy and prognosis of patients with severe acute pancreatitis, the optimal timing of treatment may be within 72 hours after onset.