摘要
目的 观察持续高流量血液滤过 (HVHF)对重症急性胰腺炎 (SAP)伴多器官功能障碍综合征(MODS)的治疗作用。方法 1997～ 2 0 0 2年 2 8例SAP伴MODS接受了HVHF治疗。APACHEⅡ评分为(14 36± 3 96 )分 ,BalthazarCT评分为 (8 5± 1 4 )分。从发病到开始HVHF时间 (6 0± 6 1)d ,HVHF治疗时间为 (4 0 4± 3 99)d。置换液以前稀释方式输入 ,流量为 4 0 0 0mL/h ,血流量 2 5 0～ 30 0mL/min ,连续 2 4h不间断。滤器为AN6 9膜 ,面积 1 2m2 ,每 2 4h更换 1次。采用低分子肝素抗凝。结果 2 8例病人中 ,2 0例治愈出院 ,2例因经济原因放弃治疗 ,6例死亡 (2 1 4 % )。HVHF后体温、心率和呼吸频率显著降低 ;APACHEⅡ评分显著下降(14 4± 3 9vs 9 9± 4 3,P <0 0 1) ;动脉血氧分压显著提高 (6 8 5± 19 5vs 91 9± 2 5 0 ,P <0 0 1)。所有病人均良好耐受HVHF治疗 ,HVHF过程中血流动力学稳定 ,未发现明显的副作用。结论 对SAP伴MODS的病人 ,HVHF明显改善体温、心率、呼吸频率、APACHEⅡ评分和动脉血氧分压。HVHF过程中血流动力学稳定 ,可能成为重要的辅助治疗措施。
Objective To investigate the effect of high-volume continuous hemofiltration (HVHF) in severe acute pancreatitis(SAP)with multiple organ dysfunction syndrome(MODS).Methods Twenty-eight SAP patients with MODS underwent HVHF from 1997 to 2002,the APACHE Ⅱ score of the patients was 14.36±3.96,and the CT severity score was 8.5±1.4.HVHF was started (6.0±6.1)days after onset of disease and sustained for (4.04±3.99)days.The ultrafiltration rate during HVHF was 4L/h,blood flow rate was 250～300mL/min,and the substitute fluid was infused with pre-dilution.AN69 hemofilter (1.2m\+2) was changed every 24 hours.Low-molecular-weight heparin was used as anticoagulant.Results Among 28 patients,20 were cured,6 died,the mortality being 21.4%.After HVHF,the temperature,heart rate,respiratory rate decreased obviously.The APACHE Ⅱ score decreased significantly after HVHF(14.4±3.9 vs 9.9±4.3,P<0.01).The PaO\-2 increased markedly from (68.5±19.5)mmHg before HVHF to (91.9±25\^0)mmHg after HVHF(P<0.01).HVHF were well tolerated in all the patients.The haemodynamic variables were stabilized during HVHF.No obvious side-effect relate to HVHF was found.Conclusion In SAP patiens with MODS,HVHF can improve the temperature,the heart rate,the respiratory rate,the APACHE Ⅱ score,and the PaO\-2 markedly.HVHF may become one of the assistant therapies to improve the outcome.
出处
《中国实用外科杂志》
CSCD
北大核心
2003年第9期549-551,共3页
Chinese Journal of Practical Surgery
基金
江苏省社会发展基金资助项目 (BS2 0 0 0 0 5 1)
