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目的 研究联合血液滤过和腹膜透析治疗急性重症胰腺炎的治疗作用及其机理。方法 将 4 0例急性重症胰腺炎患者随机分为治疗组 (2 5例 )和对照组 (15例 )。治疗组在常规保守治疗基础上使用腹膜透析和血液滤过 ,连续治疗 3d ;对照组仅常规保守治疗。比较两组的腹痛、腹胀缓解时间、CT积分、APACHEⅡ积分以及住院时间、住院费用、转手术率、并发症发生率和治愈率。比较两组外周血、腹膜透析液中TNF、IL 6、IL 8三种细胞因子在治疗前后各时相点的含量。结果 治疗组的腹痛、腹胀缓解时间、CT积分、APACHEⅡ积分、住院时间、住院费用均较对照组显著降低。治疗组三种细胞因子含量在治疗后第 1天、第 2天与治疗前以及对照组比较显著降低。结论 联合运用腹膜透析和血液滤过治疗急性重症胰腺炎疗效明显 ,清除细胞因子明显 ;对于阻止胰腺局部病变和全身病情加重有显著作用 ,而且早期治疗疗效明显。
Objective To study the therapeutic effect and mechanism of combined hemofiltration and peritoneal dialysis on acute severe pancreatitis. Methods 40 cases of severe acute pancreatitis were randomly divided into treatment group (25 cases) and control group (15 cases). The patients in the treatment group were treated with peritoneal dialysis and hemofiltration on the basis of routine conservative treatment for three days. The control group was treated only conservatively. The abdominal pain, bloating relief time, CT score, APACHE II score and length of hospital stay, hospitalization expense, rate of operation, complication rate and cure rate were compared between the two groups. The levels of TNF, IL 6 and IL 8 cytokines in peripheral blood and peritoneal dialysis fluid were compared before and after treatment. Results The treatment group had significantly lower abdominal pain, abdominal distension time, CT score, APACHE II score, hospitalization time and hospitalization expenses than the control group. The content of three cytokines in the treatment group was significantly lower on the first day and the second day after treatment than before treatment and the control group. Conclusions The combined use of peritoneal dialysis and hemofiltration in the treatment of acute severe pancreatitis has obvious curative effect and clear cytokines. It plays a significant role in preventing the local pancreatic lesions and aggravating systemic disease, and the curative effect of early treatment is obvious.