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目的分析重症急性胰腺炎(SAP)合并急性肾功能衰竭(ARF)的临床特点,并总结治疗体会。方法①回顾分析南京军区南京总医院近9年63例SAP合并ARF临床资料,用多元直线回归方法分析影响ARF发生率的相关因素;②63例病人均行肠内营养支持(62.4±20.6 d)和连续性肾脏替代治疗(CRRT)(15.6±8.7 d),51例行机械通气(21.7±12.4 d),54例早期腹腔穿刺,34例置鼻胆管或经皮经肝胆囊穿刺引流,18例行腹膜后脓肿穿刺引流,50例手术治疗。结果SAP合并ARF的死亡率为31.7%,发生率为10.6%,SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素。结论SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素;早期液体复苏、CRRT、有效维护脏器功能和局部引流是治疗成功的重要环节。
Objective To analyze the clinical features of severe acute pancreatitis (SAP) complicated with acute renal failure (ARF) and to summarize the experience of treatment. Methods ① The clinical data of 63 patients with SAP combined with ARF in Nanjing General Hospital of Nanjing Military Region were analyzed retrospectively. The factors influencing the incidence of ARF were analyzed by multivariate linear regression analysis. ② The 63 patients underwent enteral nutrition support (62.4 ± 20.6 days) and Continuous renal replacement therapy (CRRT) (15.6 ± 8.7 d), 51 patients undergoing mechanical ventilation (21.7 ± 12.4 d), 54 early abdominal paracentesis, 34 nasopharyngeal or percutaneous transhepatic gallbladder drainage and 18 patients Peritoneal abscess drainage, 50 cases of surgical treatment. Results The mortality rate of SAP with ARF was 31.7% and the incidence rate was 10.6%. The duration of SIRS, severity of illness, ARDS, MODS and abdominal compartment syndrome were the important influencing factors of ARF. Conclusion The duration of SIRS, the severity of the disease, ARDS, MODS and abdominal compartment syndrome are the important influencing factors of ARF. SAP, early liquid resuscitation, CRRT, effective maintenance of organ function and local drainage are the important links of successful treatment.