中国血液净化

›› 2003, Vol. 2 ›› Issue (7): 366-368.

• 论著 • 上一篇    下一篇

短时高容量血液滤过与间歇性血液透析治疗重症胰腺炎的疗效比较

梁馨苓 史 伟 梁永正 叶智明 金 忆 覃铁和 刘双信   

  1. 510080 广州，广东省人民医院血液净化中心 ( 梁馨苓，史伟，梁永正，叶智明，刘双信)；监护中心(金忆，覃铁和)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-07-19 发布日期:2003-07-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-07-19 Published:2003-07-19

RichHTML

1

PDF

386

摘要： 目的 比较短时高容量血液滤过（STHVH）治疗与间歇性血液透析（IHD）治疗伴急性肾功能衰 竭（ARF）的重症胰腺炎（SAP）的疗效。方法 15例伴急性肾功能衰竭的重症胰腺炎患者，9例给予短时高容量血液滤过治疗，6例接受间歇性血液透析治疗。15例患者血液净化治疗前后均纪录各项急性生理学指标及28日存活率，同时检测血肌酐、尿素氮、电解质、淀粉酶浓度、动脉血pH值及血浆肿瘤坏死因子α(TNFα)、白介素1β(IL-1β)、白介素8(IL-8)、白介素10(IL-10)的水平。结果 APACHEⅡ积分治疗前两组无差异(24.4±4.3 vs 23.2 ±3.1, P>0.05), 治疗后血滤组积分呈下降趋势，至第7日（13.2±1.6）明显低于治疗前（24.4±4.3）和血液透析组（20.2±2.3）, P<0.05。血滤组每日治疗前血肌酐、尿素氮、电解质、淀粉酶浓度、动脉血 pH值与血液透析组比较无明显差异（ P>0.05）。血滤组升压药剂量较血液透析组明显减少(P<0.05)且28天存活率血滤组与血液透析组比较(66.7% vs 33.3%, P<0.05)有显著性意义。血滤组治疗后血浆促炎症因子 TNFα、IL-1β、IL-8的水平较治疗前和血液透析组明显降低（ P<0.05），抗炎症因子 IL-10水平较治疗前和血液透析组升高（ P<0.05）。结论 短时高容量血液滤过改善伴急性肾功能衰竭的重症胰腺炎患者预后优于间歇性血液透析。

关键词: 重症急性胰腺炎, 肾功能衰竭, 血液透析, 短时高容量血液滤过

Abstract:

Objective To Compare the effects of short-term, high-volume hemofiltration (STHVH) therapy and intermittent hemodialysis (IHD) on severe acute pancreatitis (SAP) patients with acute renal failure (ARF). Methods Of 15 SAP patients with ARF, 9 received STHVH and 6 underwent IHD. In all cases, acute physiology indexes and 28-day survival rates were recorded. Blood urea nitrogen (BUN), serum creatinine (Scr), serum potassium, hydrocarbonic, and artery blood pH were detected in all patients every morning before hemopurification. Serum inflammatory cytokines such as tumor necrosis factor-α(TNF-α), interleukin-1β(IL-β), interleukin-8(IL-8) and anti-inflammatory cytokines interleukin-10 (IL-10) were detected in all patients before and after hemopurification. Results There was on difference of APACHE II score between two groups before the treatments (24.4±4.3 vs 23.2±3.1, P >0.05). In STHVH group APACHEⅡscore was lower than IHD group after treatment vs 20.2±2.3 (P<0.05). Daily mornning BUN, Scr, hydrocarbonic and artery blood pH had on difference between the two groups (P<0.05). Serum inflammatory cytokines TNF-α, IL-1β and IL-8 decreased in STHVH group comparing with IHD group after hemopurification. Serum IL-10 level increase term in STHVH group after therapy. Conclusion STHVH is of benift to improve the prognosis of SAP patients. 

Key words: Renal failure, Hemodialysis, Short-term high-volume hemofiltration