标题：连续性血液净化治疗重症急性胰腺炎合并急性肾损伤疗效观察

      作者：李辉华，王铮，黄祥卫，彭开毅    (茂名市人民医院重症医学科，广东 茂名 525000)

      卷次： 2018年29卷9期

      【摘要】 目的 探讨连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)合并急性肾损伤(AKI)患者的临床疗效。方法 选择茂名市人民医院重症医学科2015年5月至2017年8月期间收治的36例SAP合并AKI患者为研究对象，根据随机数表法分为对照组和观察组，每组18例，对照组予抗休克、抗感染等常规治疗，观察组在此基础上联合应用CBP治疗。观察两组患者治疗前及治疗7 d后血肌酐(Scr)、血尿素氮(BUN)及C反应蛋白(CRP)水平，同时记录患者APACHEⅡ评分，比较两组患者的总住院时间及 28 d死亡率。结果 治疗 7 d后，观察组患者的 Scr、BUN、CRP水平及APACHEⅡ评分分别为(107.5±15.5) μmol/L、(12.3±3.6) mmol/L、(13.2±4.8) g/L、(11.8±2.7)分，明显低于对照组的(126.5±18.8) μmol/L、(15.6±4.1) mol/L、(20.2±6.7) g/L、(13.5±2.6)分，差异均有统计学意义(P<0.05)；观察组患者的总住院时间为(22.4±3.1) d，明显短于对照组的(26.8±4.5) d，差异有统计学意义(P<0.05)；两组患者28 d死亡率(16.67% vs 27.78%)比较差异无统计学意义(P>0.05)。结论 连续性血液净化可抑制SAP合并AKI患者的炎症反应，保护患者的肾功能，缩短病程。
      【关键词】 重症急性胰腺炎；连续性血液净化；急性肾损伤；全身炎症反应综合征
      【中图分类号】 R657.5+1 【文献标识码】 A 【文章编号】 1003—6350（2018）09—1279—03

Clinical analysis of continuous blood purification in patients with severe acute pancreatitis complicated withacute kidney injury.
LI Hui-hua, WANG Zheng, HUANG Xiang-wei, PENG Kai-yi. Intensive Care Unit (ICU), MaomingPeople's Hospital, Maoming 525000, Guangdong, CHINA
【Abstract】 Objective To evaluate the efficacy of continuous blood purification (CBP) in patients with severeacute pancreatitis (SAP) complicated with acute kidney injury (AKI). Methods From May 2015 to August 2017, 36cases of SAP patients with AKI who were treated in ICU of Maoming People's Hospital were selected divided into theobservation and control group according to the random number table method. The control group received routine treat-ment of anti-shock, anti-infection, and the observation group was treated with CBP based on the treatment of the controlgroup. The levels of Scr, BUN and CRP of the two groups before and after treatment of 7 days were observed, andAPACHE Ⅱ score were recorded. The total hospitalization time and the mortality of 28 d were compared between thetwo groups. Results After 7 days of treatment, the Scr, BUN, CRP and APACHE Ⅱ score in the observation groupwere (107.5±15.5) μmol/L, (12.3±3.6) mmol/L, (13.2±4.8) mg/L, (11.8±2.7), respectively, which were significantly low-er than corresponding (126.5±18.8) μmol/L, (15.6±4.1) mmol/L, (20.2±6.7) mg/L, (13.5±2.6) in the control group (P<0.05); the total hospitalization time in the observation group was (22.4±3.1) d, significantly shorter than (26.8±4.5) d inthe control group (P<0.05); there was no significant difference in 28 d mortality rate between the two groups (16.67% vs27.78% , P>0.05). Conclusion Continuous blood purification can inhibit the inflammatory reaction of SAP patientswith AKI, protect the renal function, and shorten the course of disease.
      【Key words】 Severe acute pancreatitis (SAP); Continuous blood purification (CBP); Acute kidney injury (AKI);Systemic inflammatory response syndrome·临床经验·doi:10.3969/j.issn.1003-6350.2018.09.030