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目的观察连续静脉-静脉血液滤过(CVVH)加腹腔引流治疗重症急性胰腺炎(SAP)的临床疗效。方法31例SAP患者在接受基础治疗的同时行CVV H加腹腔引流治疗,每例次至少持续32 h;监测并计算血气分析、血生化、CRP、炎症细胞因子、血乳酸、血流动力学、氧合功能及胃粘膜内pH值、膀胱压及APACHEⅡ评分的变化。结果所有患者经治疗1天后血气分析、血生化、血乳酸、血流动力学指标、氧合功能参数、膀胱压(UBP)、炎症细胞因子及APACHEⅡ评分有显著改善P<0.01)。血pH值、胃粘膜内pH值(PHi)治疗1 d后明显升高(P<0.05),治疗3 d后,差异有统计学意义P<0.01)。结论早期、及时、合理地使用CVVH加腹腔引流,能有效减少临床并发症,降低病死率,可成为治疗SAP的重要措施。
Objective To observe the clinical efficacy of continuous venovenous hemofiltration (CVVH) and abdominal drainage in the treatment of severe acute pancreatitis (SAP). Methods Thirty-one patients with SAP were treated with CVV H plus peritoneal drainage at the same time for at least 32 hours. The blood gas analysis, blood biochemistry, CRP, inflammatory cytokines, blood lactate, hemodynamics, Oxygenation and gastric mucosal pH value, bladder pressure and APACHE Ⅱ score changes. Results All patients had significant improvement in blood gas analysis, blood biochemistry, blood lactate, hemodynamics, oxygenation function parameters, bladder pressure (UBP), inflammatory cytokines and APACHEⅡ scores after 1 day of treatment. Blood pH and gastric mucosal pH (PHi) significantly increased after 1 d of treatment (P <0.05). After 3 days of treatment, the difference was statistically significant (P <0.01). Conclusion Early, timely and rational use of CVVH plus abdominal drainage can effectively reduce clinical complications and reduce mortality, which may be an important measure for the treatment of SAP.