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目的观察传统方法联合连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)的疗效。方法 16例SAP患者在接受传统治疗的同时给予连续性静脉-静脉血液滤过(CVVH)联合血液灌流治疗。监测CBP前后患者症状、体征及血清生化指标变化,进行急性生理学及慢性健康状况评分(APACHEⅡ)、多器官功能障碍综合征(MODS)评分,监测肿瘤坏死因子α(TNFα-)、C反应蛋白(CRP)水平。结果 CBP治疗后患者发热、心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解;血清胆红素、丙氨酸氨基转移酶、淀粉酶、尿素氮、肌酐、脂肪酶水平降低,酸中毒、低氧血症纠正,APACHEⅡ、MODS评分改善,血TNF-α、CRP水平下降(P<0.05)。16例患者中12例痊愈,存活率为75%。结论传统方法治疗SAP的同时行CBP,能有效救治临床并发症,保护器官功能,降低病死率,其机制可能与清除体内炎症介质有关。
Objective To observe the curative effect of traditional method combined with continuous blood purification (CBP) on severe acute pancreatitis (SAP). Methods Sixteen patients with SAP were treated with conventional venous-venous hemofiltration (CVVH) and hemoperfusion. The changes of symptoms and signs of patients before and after CBP and the changes of serum biochemical indexes were observed. The acute physiology and chronic health status score (APACHE Ⅱ) and multiple organ dysfunction syndrome (MODS) were scored. The levels of tumor necrosis factor α (TNFα), C reactive protein CRP) levels. Results The symptoms of fever, tachycardia, respiratory distress, abdominal pain and abdominal distension were relieved in CBP patients. Serum bilirubin, alanine aminotransferase, amylase, urea nitrogen, creatinine and lipase decreased, acidosis, Hypoxemia corrected, APACHE Ⅱ, MODS score improved, blood TNF-α, CRP levels decreased (P <0.05). Twelve of 16 patients recovered, with a 75% survival rate. Conclusion The traditional method of treatment of SAP simultaneously with CBP can effectively treat clinical complications, protect organ function and reduce mortality, the mechanism may be related to clearance of inflammatory mediators in vivo.