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目的探讨连续性血液净化中的高容量血液滤过(HVHF)技术对重症急性胰腺炎患者的治疗作用。方法20例重症急性胰腺炎患者行连续性静脉-静脉HVHF,置换量3000～4000ml/h,均以前稀释方式输入,血流量250～300 ml/min,连续进行72 h以上,每24小时更换一次滤器及血路。于HVHF治疗后24、48、72 h分别行APACHEⅡ评分,并测定心率(HR)、平均动脉压(MAP),中心静脉压(CVP)、肺动态顺应性(Cdyn)和气道阻力(Raw);行血气分析,计算出氧合指数(PaO2/Fi O2)。结果HVHF治疗后48 h APACHEⅡ评分低于治疗前水平(P<0.05);HR显著减慢;PaO2、PaO2/Fi O2和Cdyn在HVHF治疗后24、48、72 h时均显著升高(P<0.05);Raw在HVHF治疗后各时间点均显著下降(P<0.05)。结论HVHF能稳定血流动力学,并通过对内环境调节、改善氧合等,从而对多个器官起到支持作用,有益于减轻病情的严重程度及改善预后。
Objective To investigate the therapeutic effect of high-volume hemofiltration (HVHF) in continuous blood purification on patients with severe acute pancreatitis. Methods Twenty patients with severe acute pancreatitis underwent continuous venovenous venous HVHF, the volume of which was 3000 ~ 4000ml / h, all of which were previously diluted. The blood flow was 250-300 ml / min, Filter and blood circuit. APACHEⅡscores were performed at 24,48,72 h after HVHF treatment, and HR, MAP, CVP, Cdyn, and airway resistance were measured. Blood gas analysis was performed to calculate the oxygenation index (PaO2 / Fi O2). Results The APACHE Ⅱ score at 48 h after HVHF treatment was lower than that before treatment (P <0.05), HR decreased significantly, PaO2, PaO2 / Fi O2 and Cdyn increased significantly at 24 h, 48 h and 72 h after HVHF treatment (P < 0.05). Raw decreased significantly at all time points after HVHF treatment (P <0.05). Conclusions HVHF can stabilize the hemodynamics, and through the regulation of the internal environment, improve oxygenation and so on, which play a supporting role in multiple organs, beneficial to reduce the severity of the disease and improve prognosis.