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目的观察连续肾脏替代疗法(continuous renal replacement therapy,CRRT)在重症急性胰腺炎(severe acute pancreatitis,SAP)中的治疗效果。方法收集2010年12月—2014年12月SAP患者50例,采用CRRT治疗。对比治疗前后患者WBC、血生化指标[C反应蛋白(C-reactive protein,CRP)、血清肌酐(serum creatinine,Scr)、尿淀粉酶(urine amylase,AMS)]、急性生理与慢性健康评分表(acute physiology and chronic health evaluation tableⅡ,APACHEⅡ)、血气分析指标[乳酸(Lac)、p H、氧合指数(PaO_2/FiO_2)]及呼吸频率、心率的变化,并统计病死率。计量资料比较采用t检验,P<0.05为差异有统计学意义。结果治疗后患者的WBC[(12.16±2.39)×109/L]和血生化指标[CRP(146.32±186.25)mg/L、Scr(191.52±152.16)μmol/L、AMS(173.67±66.51)U/L]明显低于治疗前WBC[(19.63±5.42)×109/L]、血生化指标[CRP(218.13±162.32)mg/L、Scr(345.26±319.62)μmol/L、AMS(681.52±168.15)U/L],比较差异有统计学意义(均P<0.05);治疗后血气分析指标[PaO_2/FiO_2(276.23±63.19)mm Hg、p H 12.16±2.39、Lac(1.31±0.52)mmol/L]和APACHEⅡ评分[(9.86±2.91)分]明显优于治疗前的血气分析指标[PaO_2/FiO_2(219.82±98.31)mm Hg、p H 7.31±0.09、Lac(2.62±0.59)mmol/L]和APACHEⅡ评分[(22.72±4.76)分],比较差异有统计学意义(均P<0.05);治疗后呼吸频率[(28.5±2.7)次/min]以及心率[(93.5±4.3)次/min]明显低于治疗前的呼吸频率[(43.2±3.6)次/min]以及心率[(142.6±5.2)次/min],比较差异有统计学意义(均P<0.05);患者病死率为4.00%。结论 CRRT可改善SAP患者血生化指标及血气分析指标,降低APACHEⅡ评分、呼吸频率及心率,有效改善预后。
Objective To observe the therapeutic effect of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were collected from December 2010 to December 2014 and were treated with CRRT. The changes of WBC, blood biochemical markers [C-reactive protein (CRP), serum creatinine (Scr), urine amylase (AMS)], acute physiology and chronic health score acute physiology and chronic health evaluation table Ⅱ, APACHE Ⅱ, blood gas analysis index (Lac, p H, PaO 2 / FiO 2) and respiratory rate and heart rate. Measurement data were compared using t test, P <0.05 for the difference was statistically significant. Results After treatment, WBC [(12.16 ± 2.39) × 109 / L] and blood biochemical parameters (CRP 146.32 ± 186.25 mg / L, Scr 191.52 ± 152.16 μmol / L, AMS 173.67 ± 66.51 U / L was significantly lower than that before treatment (WBC [(19.63 ± 5.42) × 109 / L], blood biochemical parameters (CRP 218.13 ± 162.32 mg / L, Scr 345.26 ± 319.62 μmol / L, AMS 681.52 ± 168.15) (P <0.05). After treatment, blood gas analysis indexes [PaO 2 / FiO 2 (276.23 ± 63.19) mm Hg, p H 12.16 ± 2.39, Lac (1.31 ± 0.52) mmol / L ] And APACHEⅡscore (9.86 ± 2.91) were significantly better than those before treatment [PaO_2 / FiO_2 (219.82 ± 98.31) mm Hg, p H 7.31 ± 0.09, Lac (2.62 ± 0.59) mmol / L] APACHEⅡscore [(22.72 ± 4.76)), the difference was statistically significant (all P <0.05); after treatment, the respiratory rate was (28.5 ± 2.7) times / min and heart rate was (93.5 ± 4.3) / min (43.2 ± 3.6) beats / min before treatment, and heart rate (142.6 ± 5.2) beats / min, with significant difference (all P <0.05); the mortality rate was 4.00% . Conclusion CRRT can improve blood biochemical parameters and blood gas analysis index of patients with SAP, reduce APACHEⅡscore, respiratory rate and heart rate, effectively improve the prognosis.