中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (05): 361-366.doi: 10.3969/j.issn.1671-4091.2014.05.002

• 临床研究 • 上一篇    下一篇

连续性静脉静脉血液滤过治疗重症急性胰腺炎并腹腔间隔室综合征

欧娅2,苏伟1,贾林2,黄耀星2,杨自力1   

  1. 广州市第一人民医院 1重症医学科 2消化内科
  • 收稿日期:2013-07-15 修回日期:2014-03-12 出版日期:2014-05-12 发布日期:2014-05-11
  • 通讯作者: 苏伟 suwei1978@126.com E-mail:yangzili8888@163.com

The effect of continuous veno- veno hemofiltraion in patients with severe acute pancreatitis and abdominal
compartment syndrome

  • Received:2013-07-15 Revised:2014-03-12 Online:2014-05-12 Published:2014-05-11

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摘要： 目的 评价连续性静脉静脉血液滤过(CVVH)对重症急性胰腺炎(SAP)并腹腔间隔室综合征(ACS)患者的疗效。 方法 2003年1月至2012年12月在广州市第一人民医院住院治疗的SAP并ACS患者54例，按患者是否接受CVVH分为CVVH组22例和对照组32例。所有患者均接受禁食、质子泵抑制剂、胃肠减压、生长抑素、抗生素治疗等处理，CVVH组在确诊SAP后立即执行治疗。使用Baxter床旁连续性血液净化机和费森尤斯AV600S血滤器，使用低分子肝素或生理盐水冲管抗凝。记录两组患者的腹部情况、腹内压(IAP)、APACHEⅡ评分、氧合指数(OI)、平均动脉压(MAP)和多巴胺用量(DA)，以及血清淀粉酶(AMS)、肌酐(Scr)、TNF-α和C反应蛋白(CRP)的水平，比较两组患者的机械通气时间、ICU停留时间和28d死亡率。 结果 (1) 治疗后3d、7d和14d，对照组患者腹胀情况和IAP均较治疗前无明显改变，治疗后28d患者腹胀减轻，IAP较治疗前明显降低(P<0.05)。治疗后7d、14d和28d，CVVH组腹胀情况和IAP均较治疗前明显降低(P<0.05)，且明显低于同期的对照组(P<0.05)；(2)治疗后3d、7d、14d和28d，两组AMS均较治疗前明显降低(P<0.05)，且在治疗后3d、7d和14d，CVVH组AMS明显低于对照组(P<0.05)；(3)治疗后7d，CVVH组APACHEⅡ评分和SOFA评分较治疗前降低(P<0.05)。治疗后14d和28d，两组APACHEⅡ评分和SOFA评分均较治疗前降低(P<0.05)。治疗后7d和14d，CVVH组APACHEⅡ评分和SOFA评分均低于对照组(P<0.05)；(4) 治疗后3d，CVVH组Scr和DA较治疗前降低(P<0.05)，MAP和OI较治疗前升高(P<0.05)。治疗后14d和28d，两组AMS、Scr和DA均较治疗前降低(P<0.05)，MAP和OI较治疗前升高(P<0.05)。治疗后3d、7d和14d，CVVH组Scr和DA低于对照组(P<0.05)，而MAP和OI高于对照组(P<0.05);(5)治疗后3d、7d、14d和28d，CVVH组TNF-α和CRP均较治疗前降低(P<0.05)。治疗后28d，对照组TNF-α和CRP均较治疗前降低(P<0.05)。治疗后3d、7d和14d，CVVH组Scr、TNF-α和CRP均低于对照组(P<0.05)；(6)CVVH组ICU停留时间和机械通气时间明显低于对照组，但两组28d死亡率比较无明显差异。 结论 CVVH可有效改善SAP并ACS患者病情，降低APACHEⅡ评分和SOFA评分，降低IAP水平，缩短ICU治疗时间和机械通气时间，保护重要脏器功能，但对28d死亡率无影响。

关键词: 连续性静脉静脉血液滤过, 重症急性胰腺炎, 腹腔内高压综合征, 急性腹腔间隔室综合征, 炎症介质

Abstract: To evaluate the effect of continuous veno-veno hemofiltraion (CVVH) on intra-abdominal pressure (IAP) in patients with severe acute pancreatitis and abdominal compartment syndrome. Methods A total of 54 patients admitted to the intensive care unit of our hospital due to severe acute pancreatitis and acute compartment syndrome in the period from 2003 to 2013 were enrolled in this study. They were divided into CVVH group (n=22) and control group (n=32). Patients in the CVVH group were additionally treated with CVVH after admitted to the ICU. Baxter portable continuous hemofiltration machine and AV600S hemofiltrator were used in the treatment. IAP, APACHE II score, sequential organ failure assessment (SOFA) score, oxygenation index (OI), mean arterial pressure (MAP), dopamine used (DA), and serum levels of creatinine (Scr), amylase (AMS), TNF-α, C-reactive protein (CRP) were assayed during the treatment. The days treated in ICU, the period on mechanical ventilation, and the 28-day mortality were compared between the two groups. Results ① After the treatment for 7, 14 and 28 days, IAP decreased significantly in CVVH group than in control group (P＜0.05); ② after the treatment for 3, 7 and 14 days, serum AMS was lower in CVVH group than in control group (P＜0.05); ③ after the treatment for 7 and 14 days, APACHE II score and SOFA score were lower in CVVH group than in control group (P＜0.05); ④ after the treatment for 3, 7 and 14 days, DA used and serum Scr were lower and MAP and OI were higher in CVVH group than in control group (P＜0.05); ⑤ after the treatment for 3, 7 and 14 days, serum TNF-α and CRP decreased more in CVVH group than in control group (P＜0.05); ⑥ the days treated in ICU and the period on mechanical ventilation were shorter in CVVH group than in control group, but the 28-day mortality was similar between the two groups. Conclusion CVVH effectively decreased APACHE Ⅱ score, SOFA score, and IAP level, with the reversal of organ dysfunctions in patients with acute compartment syndrome and severe acute pancreatitis. However, it did not change the 28-day-mortality significantly.

Key words: Continuous veno-veno hemofiltraion, Severe Acute Pancreatitis, Intra-abdominal hypertension, Acute compartment syndrome, cytokine