中国急救医学
中國急救醫學
중국급구의학
Chinese Journal of Critical Care Medicine
2015年
10期
883-887
,共5页
邹鑫森%张可祥%崔勇%潘鹏飞%周岐龙%刘超
鄒鑫森%張可祥%崔勇%潘鵬飛%週岐龍%劉超
추흠삼%장가상%최용%반붕비%주기룡%류초
连续肾脏替代疗法(CRRT)%腹腔引流%重症急性胰腺炎(SAP)%腹腔高压/腹腔间室综合征( IAH/ACS)%预后
連續腎髒替代療法(CRRT)%腹腔引流%重癥急性胰腺炎(SAP)%腹腔高壓/腹腔間室綜閤徵( IAH/ACS)%預後
련속신장체대요법(CRRT)%복강인류%중증급성이선염(SAP)%복강고압/복강간실종합정( IAH/ACS)%예후
Continuous renal replacement therapy ( CRRT)%Abdominal drainage%Severe acute pancreatitis%Intra-abdominal hypertension/abdominal compartment syndrome ( IAH/ACS)%Prognosis
目的：评价连续肾脏替代疗法（continuous renal replacement therapy ， CRRT）联合腹腔穿刺引流在防治重症急性胰腺炎（ severe acute pancreatitis ， SAP ）并发腹腔高压（ intra－abdom inal hypertension ， IAH）／腹腔间隔室综合征（ abdominal compartment syndrome ， ACS）的效果。方法将2014－01～2015－04我科收治的84例SAP患者在完成基础治疗后随机分为四组，每组21例，A组给予腹水引流；B组给予间断CRRT；C组给予间断CRRT＋引流；D组不给予间断CRRT及引流。观察各组患者APACHEⅡ评分，Balthazar CT积分，腹压，血及腹水淀粉酶、IL－6、IL－8，腹腔感染，手术情况，28 d腹腔局部并发症。结果 C组第3、7、14天的APACHEⅡ评分与A、B、D组比较差异有统计学意义（P＜0．05），且各组与治疗前比较差异有统计学意义（P＜0．05）；C组第7、14天的腹压与A、B、D组比较差异有统计学意义（P＜0．05），各组病例第7天腹压达高峰，与治疗前及第3、14天腹压比较差异有统计学意义（P＜0．05）；C组第7、14天Balthazar CT积分与A、B、D组比较差异有统计学意义（P＜0．05），C组第7天Balthazar CT 积分与治疗前比较差异有统计学意义（P＜0．05），各组第14天Balthazar CT积分与治疗前比较差异有统计学意义（P＜0．05）；C组第7、14天血、腹水中淀粉酶、IL－6、IL－8与A、B、D组比较差异有统计学意义（P＜0．05），各组与治疗前比较差异有统计学意义（P＜0．05）；同时间点腹水IL－6、IL－8高于血中各指标值（P＜0．05）；C组腹腔感染及28 d胰腺局部并发症与A、D组比较差异有统计学意义（P＜0．05）。结论 CRRT联合腹腔引流可能更有效地减轻SAP时腹腔压力、腹腔内炎症反应、腹腔感染及胰腺局部并发症。
目的：評價連續腎髒替代療法（continuous renal replacement therapy ， CRRT）聯閤腹腔穿刺引流在防治重癥急性胰腺炎（ severe acute pancreatitis ， SAP ）併髮腹腔高壓（ intra－abdom inal hypertension ， IAH）／腹腔間隔室綜閤徵（ abdominal compartment syndrome ， ACS）的效果。方法將2014－01～2015－04我科收治的84例SAP患者在完成基礎治療後隨機分為四組，每組21例，A組給予腹水引流；B組給予間斷CRRT；C組給予間斷CRRT＋引流；D組不給予間斷CRRT及引流。觀察各組患者APACHEⅡ評分，Balthazar CT積分，腹壓，血及腹水澱粉酶、IL－6、IL－8，腹腔感染，手術情況，28 d腹腔跼部併髮癥。結果 C組第3、7、14天的APACHEⅡ評分與A、B、D組比較差異有統計學意義（P＜0．05），且各組與治療前比較差異有統計學意義（P＜0．05）；C組第7、14天的腹壓與A、B、D組比較差異有統計學意義（P＜0．05），各組病例第7天腹壓達高峰，與治療前及第3、14天腹壓比較差異有統計學意義（P＜0．05）；C組第7、14天Balthazar CT積分與A、B、D組比較差異有統計學意義（P＜0．05），C組第7天Balthazar CT 積分與治療前比較差異有統計學意義（P＜0．05），各組第14天Balthazar CT積分與治療前比較差異有統計學意義（P＜0．05）；C組第7、14天血、腹水中澱粉酶、IL－6、IL－8與A、B、D組比較差異有統計學意義（P＜0．05），各組與治療前比較差異有統計學意義（P＜0．05）；同時間點腹水IL－6、IL－8高于血中各指標值（P＜0．05）；C組腹腔感染及28 d胰腺跼部併髮癥與A、D組比較差異有統計學意義（P＜0．05）。結論 CRRT聯閤腹腔引流可能更有效地減輕SAP時腹腔壓力、腹腔內炎癥反應、腹腔感染及胰腺跼部併髮癥。
목적：평개련속신장체대요법（continuous renal replacement therapy ， CRRT）연합복강천자인류재방치중증급성이선염（ severe acute pancreatitis ， SAP ）병발복강고압（ intra－abdom inal hypertension ， IAH）／복강간격실종합정（ abdominal compartment syndrome ， ACS）적효과。방법장2014－01～2015－04아과수치적84례SAP환자재완성기출치료후수궤분위사조，매조21례，A조급여복수인류；B조급여간단CRRT；C조급여간단CRRT＋인류；D조불급여간단CRRT급인류。관찰각조환자APACHEⅡ평분，Balthazar CT적분，복압，혈급복수정분매、IL－6、IL－8，복강감염，수술정황，28 d복강국부병발증。결과 C조제3、7、14천적APACHEⅡ평분여A、B、D조비교차이유통계학의의（P＜0．05），차각조여치료전비교차이유통계학의의（P＜0．05）；C조제7、14천적복압여A、B、D조비교차이유통계학의의（P＜0．05），각조병례제7천복압체고봉，여치료전급제3、14천복압비교차이유통계학의의（P＜0．05）；C조제7、14천Balthazar CT적분여A、B、D조비교차이유통계학의의（P＜0．05），C조제7천Balthazar CT 적분여치료전비교차이유통계학의의（P＜0．05），각조제14천Balthazar CT적분여치료전비교차이유통계학의의（P＜0．05）；C조제7、14천혈、복수중정분매、IL－6、IL－8여A、B、D조비교차이유통계학의의（P＜0．05），각조여치료전비교차이유통계학의의（P＜0．05）；동시간점복수IL－6、IL－8고우혈중각지표치（P＜0．05）；C조복강감염급28 d이선국부병발증여A、D조비교차이유통계학의의（P＜0．05）。결론 CRRT연합복강인류가능경유효지감경SAP시복강압력、복강내염증반응、복강감염급이선국부병발증。
Objective To evaluation the effect of continuous renal replacement therapy ( CRRT) combined with abdominal drainage on severe acute pancreatitis ( SAP ) complicated with intra-abdominal hypertension/abdominal compartment syndrome ( IAH/ACS ) .Methods Eighty -four SAP patients admitted our department and finished basal treatment from January 2014 to April 2015 were randomly divided into four groups , with 21 cases in each group .Group A: treated with the abdominal drainage; group B: treated with intermittent CRRT; group C: treated with intermittent CRRT+drainage;group D:not treat with CRRT or drainage .Clinical data were collected among all the groups, including APACHEⅡ score, Balthazar CT integral, abdominal pressure, blood and ascites amylase, IL-6, IL -8, abdominal infection , operation conditions , 28 days of intraperitoneal local complications.Results The APACHEⅡ scores in group C on 3 d, 7 d, 14 d were significant lower than those in group A, B and D, respectively (P<0.05), and the APACHEⅡ scores in all groups were significant lower than those before treatment (P<0.05).Abdominal pressure in group C on 7 d, 14 d was significant lower than that in group A , B and D, respectively (P<0.05);abdominal pressure in every group reached the peak at time of 7 d, and was significant higher than those before treatment , 3 d, 14 d of treatment (P<0.05).Balthazar CT integral in group C at time of 7 d, 14 d was significant lower than that in group A, B and D, respectively (P<0.05);Balthazar CT integral in group C at time of 7 d was significant difference than that before treatment (P<0.05); Balthazar CT integral in each group at time of 14 d was significant lower than that before treatment (P<0.05).The blood, ascites amylase, IL-6, IL-8 in group C at time of 7 d, 14 d were significant lower than those in group A , B and D, respectively (P<0.05);these indexes in each group were significantly lower than those before treatment (P<0.05);IL-6 and IL-8 in ascites at the same time point were significant higher than those in blood ( P<0.05 ) .Abdominal cavity infection and 28 days pancreatic local complications in group C were significantly different compared with those in group A and D ( P<0 .05 ) .Conclusion CRRT combined with abdominal drainage may be more effective on reducing abdominal pressure , local inflammation, abdominal cavity infection and pancreatic local complications with SAP .
