CAJ | 학술논문

目的：探讨CVVH模式治疗中/重度急性胰腺炎（MSAP/SAP）的临床疗效。方法在2011年01月至2013年12月汉中市3201医院收治的MSAP/SAP患者共82例样本进行回顾性分析。其中有43例在常规非手术治疗的基础上采用CVVH治疗，另外39例未采用CVVH治疗作为对照组。分别观察两组患者入院时及治疗72 h后各类血液生化指标的变化、APACHE-Ⅱ评分，比较两组患者住院时间、存活率、胰腺坏死发生率以及SAP发生率的差异。其中测量数据资料比较采用独立样本t检验，发生率比较采用χ2检验，并采用重复测量数据方差分析生成线图，以直观地反映疗效差异，以P＜0.05为差异有统计学意义。结果两组患者的年龄、以及入院时所测的APACHE-Ⅱ评分、年龄、多项重要生化指标比较无统计学差异（P＞0.05）。治疗72 h后CVVH治疗组的临床症状较对照组改善明显，复测APACHE-Ⅱ评分、ALT、AST、BUN、UA、TG、CRP等指标均下降明显，其差异有统计学意义（P＜0.05）；两组患者住院时间的差异有统计学意义；患者存活率、SAP发生率、IAH发生率及胰腺坏死率的差异有统计学意义（P＜0.05）。结论治疗MSAP/SAP在常规综合治疗的基础上及时采用CVVH治疗，可在发病早期有效清除血液中的炎性介质及内毒素，对人体内环境的稳定、早期细胞组织氧合作用的改善以及拮抗器官的功能衰竭有积极作用，可有效改善预后，阻止部分MSAP进展为SAP，减少并发症的发生，降低住院天数。
목적：탐토CVVH모식치료중/중도급성이선염（MSAP/SAP）적림상료효。방법재2011년01월지2013년12월한중시3201의원수치적MSAP/SAP환자공82례양본진행회고성분석。기중유43례재상규비수술치료적기출상채용CVVH치료，령외39례미채용CVVH치료작위대조조。분별관찰량조환자입원시급치료72 h후각류혈액생화지표적변화、APACHE-Ⅱ평분，비교량조환자주원시간、존활솔、이선배사발생솔이급SAP발생솔적차이。기중측량수거자료비교채용독립양본t검험，발생솔비교채용χ2검험，병채용중복측량수거방차분석생성선도，이직관지반영료효차이，이P＜0.05위차이유통계학의의。결과량조환자적년령、이급입원시소측적APACHE-Ⅱ평분、년령、다항중요생화지표비교무통계학차이（P＞0.05）。치료72 h후CVVH치료조적림상증상교대조조개선명현，복측APACHE-Ⅱ평분、ALT、AST、BUN、UA、TG、CRP등지표균하강명현，기차이유통계학의의（P＜0.05）；량조환자주원시간적차이유통계학의의；환자존활솔、SAP발생솔、IAH발생솔급이선배사솔적차이유통계학의의（P＜0.05）。결론치료MSAP/SAP재상규종합치료적기출상급시채용CVVH치료，가재발병조기유효청제혈액중적염성개질급내독소，대인체내배경적은정、조기세포조직양합작용적개선이급길항기관적공능쇠갈유적겁작용，가유효개선예후，조지부분MSAP진전위SAP，감소병발증적발생，강저주원천수。
Objective To investigate the clinical efficacy of CVVH mode in the treatment of moderate/severe acute pancreatitis(MSAP/SAP).Methods In the MSAP/SAP patients of 3201 Hospitals of Hanzhong City from January 2011 to December 2013 , a total of 82 cases of samples were retrospectively analyzed.There are 43 cases in which the use of CVVH treatment based on conventional non-surgical therapy, another 39 patients without the use of CVVH treatment as a control group .To observe the changes of various types of blood biochemical parameters , APACHE-Ⅱ score after 72 hours’ treatment of the two groups of patients respectively. To compare the difference of hospitalization , survival , incidence rate of pancreatic necrosis and SAP between the two groups of patients, which the measurement data were compared in the using of independent samples t test , and the incidence rate were compared in the using of x2 test, and using repeated measurement data of variance analysis to generate charts, to reflect the difference of efficacy visually, andP<0.05 was considered statistically significant.Results The age and measured admission APACHE-Ⅱ score , age, numbers of important biochemical markers of both groups were no significant difference(P>0.05). After 72 hours’ treatment, the clinical symptoms of CVVH treatment group compared with the control group improved significantly, and the retest APACHE-Ⅱ score, ALT, AST, BUN, UA, TG, CRP and other indicators are significantly decreased, in which the difference was statistically significant(P<0.05).The difference of hospitalization between the two groups were statistically significant.The difference of patient survival, incidence rate of SAP, IAH and pancreatic necrosis was statistically significant(P<0.05).Conclusion In the treatment of MSAP/SAP on the basis of routine treatment on the timely adoption of CVVH treatment can effectively remove the inflammatory mediators and endotoxin in the blood in the early onset, which can keep a stable environment for the human body ,can improve the failure of early tissue oxygenation and antagonistic organ with a positive effect , can effectively improve outcomes, prevent some MSAP progress to SAP, to reduce the incidence of complications, and to reduce the number of days of hospitalization.