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目的:比较脉冲式高容量血液滤过(PHVHF)与连续性血液滤过(CVVH)治疗重症急性胰腺炎(SAP)的疗效。方法:38例SAP患者随机接受PHVHF或CVVH治疗,分别为18例及20例,血滤72h后观察两组治疗前后临床症状,急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分,生化指标的改变及病死率。结果:治疗后两组症状明显改善,APACHEⅡ评分、血清淀粉酶、肝功能、血肌酐、白细胞和CRP均有下降(P<0.05)。低氧血症,酸中毒纠正,PHVHF组优于CVVH组,在心率、呼吸、肝功能、APACHEⅡ评分方面差异显著(P<0.05)。PHVHF组病死率为11.1%,CVVH组为25%。结论:PHVHF治疗SAP效果显著,明显优于CVVH组,可以作为SAP的重要辅助治疗。
Objective: To compare the efficacy of pulsed high volume hemofiltration (PHVHF) and continuous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP). Methods: Thirty-eight patients with SAP were randomized to receive PHVHF or CVVH, 18 and 20, respectively. After 72 hours of hemofiltration, the clinical symptoms, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores and biochemical indexes were observed before and after treatment And fatality rate. Results: After treatment, the symptoms of both groups were significantly improved. APACHE Ⅱ score, serum amylase, liver function, serum creatinine, white blood cells and CRP all decreased (P <0.05). Hypoxemia and acidosis were corrected. PHVHF group was superior to CVVH group in heart rate, respiration, liver function and APACHEⅡ scores (P <0.05). The case fatality rate was 11.1% in the PHVHF group and 25% in the CVVH group. Conclusion: The effect of PHVHF on SAP is significant, which is obviously superior to CVVH group and can be used as an important adjuvant therapy for SAP.