罗育红等

[摘要] 目的 探讨连续性血液净化对重症胰腺炎以及降钙素原的影响情况，为临床治疗重症胰腺炎的方法提供依据。方法 选取2010～2013年就诊于秦皇岛市第二医院的重症胰腺炎患者108例，采用随机数字法将其分为连续性血液净化组及常规治疗组，每组各54例。比较两组的治疗效果，比较分析两组患者的临床症状缓解、住院负担情况以及治疗前后APACHEⅡ评分、降钙素原、血清酶水平。 结果 连续性血液净化组的治愈率为88.89%，明显高于常规治疗组（66.67%），差异有高度统计学意义（P < 0.01）。连续性血液净化组住院费用和住院时间方面明显少于常规治疗组，差异有高度统计学意义（P < 0.01）；连续性血液净化组腹胀以及腹痛缓解所需时间明显少于常规治疗组，差异有高度统计学意义（P < 0.01）。经过多因素多水平的重复资料的方差分析，连续性血液净化组不同时间APACHEⅡ评分比较，差异有高度统计学意义（P < 0.01）；治疗后两组降钙素原、血清淀粉酶均明显降低，且连续性血液净化组下降情况明显优于常规治疗组，差异均有统计学意义（P < 0.05）。 结论 连续性血液净化对治疗重症胰腺炎，降低降钙素原、血清淀粉酶方面较常规治疗更加经济高效，可提高治愈率，为重症胰腺炎的治疗方法提供一定的依据。

[关键词] 重症胰腺炎；连续性血液滤过；降钙素原；疗效

[中图分类号] R576 [文献标识码] A [文章编号] 1673-7210（2015）06（c）-0019-04

Effect of continuous hemofiltration on patients with severe acute pancreatitis

LUO Yuhong1 ZHANG Hui1 ZHANG Xueyan2 TIAN Min2

1.Intensive Medicine， the Second Hospital of Qinhuangdao， Hebei Province， Qinhuangdao 066600， China； 2.Endocrinology， People's Hospital of Changli County， Hebei Province， Qinhuangdao 066600， China

[Abstract] Objective To investigate the effects of continuous blood purification on patients with severe acute pancreatitis and procalcitonin， and provide the basis for clinical treatment of severe acute pancreatitis. Methods 108 patients with severe acute pancreatitis from 2010 to 2013 in the Second Hospital of Qinhuangdao were selected， and according to the random number method， they were divided into continuous blood purification group and conventional treatment group， with 54 cases in each group. The treatment effect of two groups were compared， and clinical symptoms， hospital burden condition and APACHE Ⅱ score， calcitonin， serum enzyme before and after treatment of two groups were analyzed and compared. Results The curative effect the cure rate of the continuous blood purification group was 88.89%， which was significantly higher than that of the conventional treatment group （66.67%）， the difference was statistically significant （P < 0.01）； hospitalization expenses and hospitalization time of the continuous blood purification group were obviously less than those of the conventional treatment group， the differences were statistically significant （P < 0.01）； relief time of abdominal distension， abdominal pain of patients in the continuous blood purification group were less than those of the conventional treatment group， the differences were statistically significant （P < 0.01）. After variance analysis of repeated data at multiple factors level， APACHE Ⅱ score of the continuous blood purification group at different time was statistically significant （P < 0.01）. Calcitonin original， serum amylase of two groups after treatment were declined， and the continuous blood purification group was obviously better than conventional treatment group， the differences were statistically significant （P < 0.05）. Conclusion Continuous blood purification in the treatment of severe acute pancreatitis， reduce the procalcitonin， serum amylase is more economical and efficient than conventional treatment， can improve the cure rate， to provide a basis for the treatment of severe acute pancreatitis.

[Key words] Severe acute pancreatitis； Continuous blood purification； Procalcitonin； Curative effect

重症胰腺炎即出血坏死性胰腺炎，是一种病死率高、病情险恶急腹症，其特点是并发症多、危害大、全身炎症、多变复杂。一般认为病死率达20%～30%。既往采用手术治疗重症胰腺炎，近年多采用综合治疗方法治疗[1]。而目前部分学者认为降钙素原（PCT），作为针对炎性反应有放大效应作用的继发介质，对全身性炎症有一定的诊断价值，因此可以考虑将降钙素原作为新型重症感染的一种检测指标[2]。由于连续性血液滤过在器官功能支持以及水电解质平衡紊乱、免疫调节和酸碱代谢紊乱的治疗多个方面效果显著，成为内科治疗常规辅助方法。我国1998年将其引入治疗重症胰腺炎[3-4]。本次研究探讨连续性血液净化对重症胰腺炎以及降钙素原的影响情况，为临床治疗重症胰腺炎的方法提供依据。

1 对象与方法