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目的 :C 反应蛋白 (C reactiveprotein ,CRP)是一种急性时相蛋白 ,是早期评价急性胰腺炎严重程度及其预后的有效血清学参数 ,本文研究了连续性高容量血液滤过对重症急性胰腺炎 (SAP)患者CRP的影响和临床意义。 方法 : SAP患者 2 3例 ,男性 15例 ,女性 8例 ,平均年龄 2 7～ 73(47 7± 13 6 )岁 ,其诱因分别为胆源性胰腺炎 15例 ,酒精性胰腺炎 2例 ,高脂血症性胰腺炎 2例 ,兼有多种因素者 1例 ,原因不明者 3例。入院时APACHEⅡ评分为 6～ 2 0 (11 6± 4 36 )分。合并急性呼吸窘迫综合征 /急性肺损伤 (ARDS/API) 2 2例 ,呼吸机治疗 13例 ,少尿型急性肾衰 (ARF) 5例 ,低血压休克 5例 ,胰性脑病 6例。患者入院明确诊断之后 ,即在床边行连续性高容量静脉 静脉血液滤过 (CHVHF) ,连续治疗 72h不间断。所用滤器为AN6 9膜 ,面积 1 2m2 ,每隔 2 4h更换一次。治疗中血流量为 2 5 0ml/min ,置换液量定为 4 0 0 0ml/h ,前稀释方式输入 ,超滤量根据治疗量和患者容量负荷情况设定。 结果 :2 3例患者中 ,存活 2 0例 (存活率 87 0 % ) ;死亡 3例 (死亡率 13 0 % )。实际CHVHF治疗时间为 6 7～ 76h ,平均(71 95± 1 33)h ,实际超滤率为 (396 6 4± 2 4 0 2 )ml/h。行CHVHF治疗后发热、心动过速等症状明显好转、血
Objective: C reactive protein (CRP), an acute phase protein, is an effective serological parameter to evaluate the severity and prognosis of acute pancreatitis in early stage. This study investigated the effect of continuous high-volume hemofiltration on severe acute pancreatitis Influence and clinical significance of CRP in patients with inflammation. Methods: Twenty-three SAP patients, 15 males and 8 females, average age ranged from 27 to 73 years (47 7 ± 13 6 years). The causes were 15 cases of biliary pancreatitis, 2 cases of alcoholic pancreatitis, 2 cases of hyperlipidemic pancreatitis, a combination of multiple factors in 1 case, 3 cases of unknown cause. APACHE Ⅱ score at admission was 6 ~ 20 (11 6 ± 4 36) points. There were 22 cases of acute respiratory distress syndrome / acute lung injury (ARDS / API), 13 cases of ventilator therapy, 5 cases of oliguric acute renal failure (ARF), 5 cases of hypotension shock and 6 cases of pancreatic encephalopathy. Patients admitted to hospital after a clear diagnosis, that is, continuous bedside high-capacity venous venous hemofiltration (CHVHF), continuous treatment 72h uninterrupted. The filter used was an AN6 9 membrane with an area of 12 m2, which was changed every 24 hours. The blood flow during treatment was 250 ml / min and the replacement fluid volume was set at 400 ml / h, which was input before dilution. The amount of ultrafiltration was set according to the amount of treatment and patient capacity load. Results: Of the 23 patients, 20 survived (survival rate 87.0%) and 3 died (mortality rate 130%). The actual treatment time for CHVHF ranged from 67 to 76 hours, with an average of 71 95 ± 1 33 h and an actual ultrafiltration rate of (396 64 ± 2 422) ml / h. After CHVHF treatment fever, tachycardia and other symptoms improved significantly, blood