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目的:探讨杂合式肾脏替代治疗(HRRT)对重症急性胰腺炎(SAP)患者的疗效。方法:2007年2月～2010年4月行HRRT治疗SAP患者13例,均采用中心静脉置管建立血管通路,采用普通肝素或低分子肝素抗凝,每天治疗时间8～12h。观察患者行HRRT前后生化指标、APACHEⅡ评分的变化以及临床转归。结果:HRRT治疗后患者血清肌酐(Scr)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血淀粉酶(P-AMY)、尿淀粉酶(U-AMY)水平明显低于HRRT治疗前水平(P<0.05);HRRT治疗1、2、7d后患者的APACHEⅡ评分分别为8.2±2.5、6.4±1.6、4.1±1.1,均明显低于治疗前的16.3±4.6,差异有显著统计学意义(P<0.01);13例患者中1例于第1次治疗时死亡,1例于第2次HRRT后放弃继续治疗,余下11例患者经HRRT治疗后治愈好转出院,总的治愈好转率为92.3%,病死率为7.7%。结论:HRRT可能是治疗SAP的一种有效的辅助治疗方法,能降低患者的病死率,提高治愈好转率。
Objective: To investigate the effect of heterozygous renal replacement therapy (HRRT) on patients with severe acute pancreatitis (SAP). Methods: From February 2007 to April 2010, 13 patients with SAP were treated with HRRT. All the patients were treated with central venous catheter to establish the vascular access. The patients were treated with unfractionated heparin or low molecular weight heparin anticoagulant. The daily treatment time was 8-12h. The biochemical indexes of patients before and after HRRT, changes of APACHEⅡscore and clinical outcome were observed. Results: The levels of serum creatinine, aspartate aminotransferase, ALT, P-AMY and U-AMY in HRRT group were significantly lower than those before HRRT (P <0.05). The APACHEⅡscores of patients after HRTT for 1, 2 and 7 days were 8.2 ± 2.5, 6.4 ± 1.6 and 4.1 ± 1.1, respectively, which were significantly lower than those before treatment (16.3 ± 4.6), with significant difference P <0.01). One of the 13 patients died on the first treatment, and one patient discontinued treatment after the second HRTT. The remaining 11 patients were cured and discharged after being treated with HRTT. The overall improvement rate was 92.3 %, Case fatality rate was 7.7%. Conclusion: HRRT may be an effective adjuvant therapy for SAP, which can reduce the mortality of patients and improve the cure rate.