早期血液滤过对重症急性胰腺炎合并腹腔间隔室综合征的影响

Early continuous veno-venous hemofiltration for treatment of abdominal compartment syndrome with severe acute pancreatitis

摘要:

目的研究早期血液滤过对重症急性胰腺炎（SAP）合并腹腔间隔室综合征（ACS）患者各脏器功能及腹内压的影响。方法选取SAP合并ACS患者48例，其中37 例（治疗组）除在ICU进行常规治疗外，同时进行血液滤过治疗；其余11 例（对照组）因经济困难等原因未行血液滤过和手术治疗，只行常规治疗。治疗期间观察并记录两组患者的症状、体征及不良反应。于治疗前和治疗后1～6 d 检测患者血尿淀粉酶、肝肾功能及C 反应蛋白（CRP），同时测定患者的腹内压。结果治疗组患者症状体征消失时间、住院时间较对照组缩短（p <0.05）。治疗组治疗后1～6 d 患者血尿淀粉酶、肝肾功能、CRP 及腹内压低于对照组（p <0.05）。结论早期血液滤过能有效降低SAP 合并ACS 患者的腹内压，改善症状，促进肝肾功能尽快恢复，避免多脏器功能衰竭，降低死亡率。

Abstract:

Objective To investigate the efficacy of continuous veno-venous hemofiltration (CVVH) in patients with abdominal compartment syndrome (ACS) and severe acute pancreatitis (SAP) and the effect on organ function and intra-abdominal hypertension (IAP). Methods Of the 48 ACS patients with SAP, 37 were selected as treatment group to be treated in the Intensive Care Unit and underwent CVVH in addition to conventional treatment, 11 did not undergo CVVH or surgical treatment due to various reasons such as economic hardship and were selected as control group. During treatment, patients' symptoms, signs and side effects were observed and recorded. Blood or urine amylase, hepatic and renal functions, C-reactive protein (CRP) and intra-abdominal pressure (IAP) were measured before treatment and on the 1st-6th days after treatment. Results The time of symptom and sign disappearance and hospitolization time in the treatment group were significantly shorter than those in the control group (p < 0.05). Serum and urine amylase levels,serum ALT, AST and CRP levels in the treatment group were significantly decreased on the 1st-6th days after CVVH, and significantly lower than those in the control group (p < 0.05). IAP in the treatment group on the 1st-6th days after CVVH was significantly lower than that in the control group on the corresponding day(p < 0.05). Conclusions Early CVVH can effectively decrease the IAP in ACS patients with SAP, rapidly improve the symptoms, accelerate recovery of liver and kidney functions, avoid multiple organ failure and reduce mortality.