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目的:探讨早期采用益活清下法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)并肾功能不全的疗效。方法:35例符合病例选择标准并接受益活清下法治疗的SAP并发肾功能不全患者,按发病后入院时间分为早期组(3d内入院接受治疗,24例)和晚期组(3~7 d内入院接受治疗,11例),比较治疗过程中两组患者各并发症的持续时间、病程、手术中转率及病死率。结果:两组入院48小时Ranson评分、急性生理和慢性健康评价指标Ⅱ(APACHEⅡ)评分及CT评分比较差异无显著性(P>0.05);早期组急性呼吸窘迫综合征、肾功能不全的持续时间低于晚期组(P<0.05);早期组和晚期组中转手术率分别12.5%(3/24例)和18.18%(2/11例),差异无统计学意义(P>0.05);病死率早期组和晚期组分别为8.33%(2/24例)和9.09%(1/11例),差异无统计学意义(P>0.05);早期组和晚期组住院病程分别为(20.40±18.25)d和(34.92±12.62)d,两组比较有统计学意义(P<0.05)。结论:早期使用益活清下法对SAP合并肾功能不全可以取得更好疗效。
Objective: To investigate the curative effect of early treatment of patients with severe acute pancreatitis (SAP) and renal insufficiency by using Yixinqingxia method. Methods: 35 patients with SAP complicated with renal insufficiency who met the criteria of case selection and were treated with Yixin Qingxia method were divided into early group (24 cases admitted to hospital within 3 days) and late stage group (3 to 7 d admitted to hospital for treatment, 11 cases), compared the duration of treatment of complications in both groups, duration of disease, surgical transfer rate and mortality. Results: There was no significant difference in Ranson score, acute physiology and chronic health evaluation index (APACHEⅡ) score and CT score between the two groups at 48 hours after admission (P> 0.05); the early stage of acute respiratory distress syndrome, duration of renal insufficiency (P <0.05). The rate of operation in the early group and the late group was 12.5% (3/24 cases) and 18.18% (2/11 cases) respectively, with no significant difference (P> 0.05). The mortality rate There was no significant difference between the early group and the late group (8.33% (2/24 cases) and 9.09% (1/11 case, P> 0.05). The hospitalization duration in the early and late groups were (20.40 ± 18.25) d and (34.92 ± 12.62) d, respectively. There was a significant difference between the two groups (P <0.05). Conclusion: The early use of Yihuo Qingxia method combined with renal insufficiency can achieve better results.