连续肾脏替代疗法治疗重症急性胰腺炎时机的探讨

目的:探讨连续肾脏替代疗法(CRRT)治疗重症急性胰腺炎的最佳时机。方法:选取我院收治的30例重症急性胰腺炎(SAP)患者为研究对象,按发病后行CRRT的时间分将患者随机为A、B两组,A组发病后72小时内治疗,B组发病后72小时后治疗,分析和比较两组治疗后的临床转归及生命体征变化、APACHEⅡ评分变化急性生理与慢性健康状况、住院费用、平均住院时间。结果:经CRRT治疗后,A组死亡率(14.3%)低于B组(43.7%),差异有统计学意义(P0.05);A、B两组治疗后体温、心率、呼吸、平均动脉压平稳,A组优于B组,差异有统计学意义(P0.05);A组的平均住院时间(15.7±8.9)d、住院费用(107000±65000)万元均明显优于B组,差异有统计学意义(P0.05);两组患者治疗后APACHEⅡ评分均明显优于治疗前,治疗后A组APACHEⅡ评分明显优于B组,差异显著有统计学意义(P0.05)。结论:早期行CRRT能明显改善重症急性胰腺炎患者的疗效和预后,最佳治疗时机可能为发病后72小时内。

Research on the Application Time of Continuous Renal ReplacementTherapy for Severe Acute Pancreatitis

Objective:To discuss the best application time of continuous renal replacement therapy for severe acute pancreatitis.Methods:30 cases of patients with severe acute pancreatitis (SAP) were selected in our hospital as the research object, according to theonset of CRRT after time, they were divided into group A and group B. Group A was treated within 72h after onset, while Group B wastreated in the pathogenesis of 72 h. The clinical outcome and changes of invital signs, APACHE II score, hospitalization costs and averagehospitalization time were analyzed.Results:After the CRRT, the mortality rate (14.3%) of Group A was lower than that of group B(43.7%), the difference was statistically significant (P<0.05); after the treatment, two groups of treatment, heart rate, respiratory rate andmean arterial pressure were stable, Group A was better than that of group B, and the difference was statistically significant (P<0.05); Theaverage hospitaliza- tion time (15.7± 8.9) days, hospitalization costs (107000± 65000)yuan of group A were significantly better thanthose in group B, with significant difference (P<0.05); the APACHE II score after the treatment of the two groups were significantly higherthan those before treat- ment, group A APACHE II score was significantly better than that in group B, the difference was significant(P<0.05).Conclusion:Early continuous renal replacement therapy can significantly improve the curative effect and prognosis of acutepancreatitis, and the optimal timing of treatment may be within 72 hours after onset.