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1、内科急危重症杂志2010年第16卷第3期139持续性与间歇性血液净化治疗重症急性胰腺炎合并急性肾衰竭的疗效比较*华中科技大学同济医学院附属同济医院李永胜高红宇于丹周亚光李树生杨光田,武汉430030摘要目的:比较持续性血液净化(CBP)与间歇性血液透析治疗(IHD)对重症急性胰腺炎(SAP)合并急性肾衰竭(ARF)等多器官功能障碍的治疗效果。方法:SAP合并急性肾衰竭患者49例,其中28例行CBP(CBP组),21例行IHD(IHD组)。均于血液净化治疗前以及治疗后的第1~7天记
2、录生命体征、采血检测血白细胞、肝肾功能、动脉血气等,并比较APACHE评分以及患者的转归。结果:在血液净化治疗后的第1、3天,IHD对血BUN、Scr的清除作用强于CBP组(P<0.05),但透析中发生低血压的次数明显较高(P<0.05);CBP对动脉血PaO2以及-HCO3的改善较IHD组明显(P<0.05),CBP组的体温、心率、血WBC计数及APACHE评分较IHD组显著下降(P<0.05),患者24h尿量达到750ml的时间及平均住院日均明显短于IHD组(P<0.05),但两组的病死率无
3、显著性的差异。结论:两种血液净化模式均可以使SAP患者的血BUN、Scr明显降低,电解质和酸碱平衡紊乱迅速纠正;CBP时血流动力学较IHD稳定,对全身炎性反应的疗效优于IHD。关键词连续性肾脏替代治疗间歇性血液透析治疗重症急性胰腺炎急性肾衰竭中图分类号R459.5R576文献标识码AComparisonofTherapeuticEffectofContinuousandIntermittentHemodialysisonSevereAcutePancreatitisComplica
4、tingAcuteRenalRailureLIYongsheng,GAOHongyu,YUDan,etal.TongjiHospitalAffiliatedtoTongjiMedicalCollege,HuazhongUniversityofScienceandTechnology,Wuhan430030,ChinaAbstractObjective:Tocomparethetherapeuticeffectofcontinuousbloodpurification(CBP)andintermitt
5、enthemodialysis(IHD)onsevereacutepancreatitis(SAP)complicatingacuterenalfailure(ARF).Methods:FortyninepatientswithSAPcomplicatingARFweredividedintotwogroupsinwhich28patientsweretreatedwithCBP(CBPgroup)and21patientswithIHD(IHDgroup).Vitalsigns,bloodsampl
6、eforleukocyticcount,liverandrenalfunction,arterialbloodgasanalysisweredetectedbeforeandafterbloodpurificationfromthe1stto7thdays,meanwhile,theAPACHEscoreandprognosiswererecordedandanalyzed.Results:TheeffectofIHDtoclearstrdbloodBUNandScrwasbetterthanCB
7、Ponthe1and3dayaftertheinitiationofbloodpurificationtherapy(P<0.05),buttheoccurrenceofhypotensionincreasedsignificantly(P<0.05);CBPimprovedarterialbloodPaO2and-HCO3remarkablycomparedwiththatofIHD(P<0.05),thebodytemperature,heartrate,bloodWBCcountandAPACHE
8、scoreinCBPgroupdecreasedsignificantlycomparedwiththoseofIHDgroup(P<0.05),thetimeofreaching750mlurinaryvolumein24hoursandtheaveragestayinhospitalinCBPgroupwereremarkablyshorterthanthoseinIHDgroup(P<0.05),butthemortalityha
