CAJ | 학술논문

目的比较持续性静脉-静脉血液滤过治疗(CVVH)与反复间断静脉-静脉血液滤过治疗(RIVVH)对重症急性胰腺炎(SAP)的治疗效果.方法收集2011年1月至2014年6月,武汉市中心医院重症医学科SAP住院患者56例.其中28例行CVVH治疗,28例行RIVVH治疗.比较2组患者治疗前后生命体征、APACHEⅡ评分、MODS评分变化;监测治疗前后血淀粉酶、脂肪酶、血浆炎症因子(TNF-α、IL-6、IL-8)水平;统计其机械通气时间、升压药物应用时间、ICU住院时间、需外科干预患者比例及病死率.结果两组患者治疗后临床症状均有所缓解,其APACHEⅡ评分、MODS评分、血淀粉酶、脂肪酶、血浆炎症因子水平均下降(P＜0.05).但CVVH治疗组患者APACHEⅡ评分、MODS评分、血淀粉酶、血浆炎症因子水平在相同时间点均明显低于RIVVH组(P＜0.05);CVVH组转归明显优于RIVVH组(P＜0.05).结论 CVVH治疗能有效改善SAP患者临床症状、提高生存率,有望成为其重要的辅助治疗措施.
목적 비교지속성정맥-정맥혈액려과치료(CVVH)여반복간단정맥-정맥혈액려과치료(RIVVH)대중증급성이선염(SAP)적치료효과.방법 수집2011년1월지2014년6월,무한시중심의원중증의학과SAP주원환자56례.기중28례행CVVH치료,28례행RIVVH치료.비교2조환자치료전후생명체정、APACHEⅡ평분、MODS평분변화;감측치료전후혈정분매、지방매、혈장염증인자(TNF-α、IL-6、IL-8)수평;통계기궤계통기시간、승압약물응용시간、ICU주원시간、수외과간예환자비례급병사솔.결과 량조환자치료후림상증상균유소완해,기APACHEⅡ평분、MODS평분、혈정분매、지방매、혈장염증인자수평균하강(P＜0.05).단CVVH치료조환자APACHEⅡ평분、MODS평분、혈정분매、혈장염증인자수평재상동시간점균명현저우RIVVH조(P＜0.05);CVVH조전귀명현우우RIVVH조(P＜0.05).결론 CVVH치료능유효개선SAP환자림상증상、제고생존솔,유망성위기중요적보조치료조시.
Objective To compare the therapeutic effects of continuous veno-venous hemofiltration (CVVH) versus repeated intermittent veno-venous hemofiltration (RIVVH) on patients with severe acute pancreatitis (SAP).Methods Fifty-six patients with SAP were randomly divided into the CVVH group (n =28) and the RIVVH group (n =28).The clinical symptoms and signs,the APACHE Ⅱ and MODS scores,the result of biochemistry including amylase and lipase,and the plasma levels of TNF-α,IL-6,IL8 before and after treatment,the duration of mechanical ventilation,boosting drug application time,the length of stay in ICU,the surgical intervention rate and the mortality were compared between the two groups.Results The clinical symptoms improved in the two groups after treatment (P ＜ 0.05).The APACHE Ⅱ and MODS scores were all reduced in the two groups after treatment (P ＜ 0.05).When compared with the RIVVH group,the result of biochemistry including amylase and lipase,and the plasma levels of TNF-α,IL6,IL-8 were significantly decreased (P ＜ 0.05).The duration of mechanical ventilation,the length of stay in ICU and the mortality were also significantly decreased in the CVVH group (P ＜ 0.05).Conclusions CVVH was more efficacious than RIVVH in the treatment of SAP.