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目的评价早期反复间断静脉-静脉血滤(repeated intermittent veno-venous hemofiltration,RIVVH)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的价值。方法65例SAP患者随机分为RIVVH组(35例)和对照组(30例)。比较2组患者的生命体征、临床表现、血糖、氧合指数、肝肾功能、淀粉酶、脂肪酶、C-反应蛋白的变化、细菌培养阳性率、治疗前及治疗后的Balthazar CT评分、APACHEⅡ评分、开腹手术率、并发症发生率、死亡率、治愈率、平均住院时间以及费用。结果RIVVH组35例中2例死于MODS,死亡率为5.7%,对照组死亡8例(26.7%),其差异有统计学意义(P<0.05);RIVVH组治愈率为94.3%(33/35),优于对照组的73.3%(22/30),P<0.05。RIVVH组治疗后患者的生命体征、腹部体征、血生化指标、氧合指数和C-反应蛋白水平均明显趋于改善,与对照组比较其差异有统计学意义(P<0.05,P<0.01);RIVVH组Balthazar CT和APACHEⅡ评分较对照组显著降低(P=0.002,P<0.001);感染发生率也较对照组显著降低(P<0.001)。在缩短平均住院时间,降低平均治疗费用、开腹手术率和并发症发生率方面RIVVH组明显优于对照组(P<0.05)。结论早期RIVVH治疗SAP有望成为SAP重要的辅助治疗措施。
Objective To evaluate the value of early repeated intermittent veno-venous hemofiltration (RIVVH) in the treatment of severe acute pancreatitis (SAP). Methods 65 patients with SAP were randomly divided into RIVVH group (35 cases) and control group (30 cases). The changes of vital signs, clinical manifestations, blood glucose, oxygenation index, liver and kidney function, amylase, lipase and C-reactive protein, positive rate of bacterial culture, Balthazar CT score before and after treatment, APACHEⅡ Score, open surgery rate, complication rate, mortality, cure rate, average length of stay, and cost. Results In the RIVVH group, 2 of 35 patients died of MODS, the mortality rate was 5.7%, while the control group was 8 (26.7%), the difference was statistically significant (P <0.05). The cure rate of RIVVH group was 94.3% (33 / 35), better than the control group 73.3% (22/30), P <0.05. Vital signs, abdominal signs, blood biochemical indices, oxygenation index and C-reactive protein levels in RIVVH group were significantly improved after treatment, which were significantly different from those in control group (P <0.05, P <0.01) . The Balthazar CT and APACHEⅡ scores in RIVVH group were significantly lower than those in control group (P = 0.002, P <0.001). The incidence of infection was significantly lower than that in control group (P <0.001). The RIVVH group was significantly better than the control group (P <0.05) in reducing average length of hospital stay, reducing the average cost of treatment, the rate of laparotomy and the incidence of complications. Conclusion Early treatment of RIVVH SAP is expected to become an important adjuvant SAP treatment.