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目的:研究早期短时静脉-静脉血液透析滤过(short veno-venous hemodiafiltration,SVVHDF)对重症急性胰腺炎(severe acute pancreatitis,SAP)病人合并急性肾损伤(acute kidney injury,AKI)的治疗效果。方法:SAP合并AKI的25例病人包括SVVHDF组(15例)和对照组(10例)。监测两组病人治疗前、后血清肌酐(Cr)、血尿素氮(BUN)、血pH值和APACHEⅡ评分的变化,以及SVVHDF组病人在SVVHDF治疗过程中呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、电解质(K+、Na+及Cl-)、临床症状和体征的变化。结果:SVVHDF治疗12 h后,SVVHDF组病人的BUN、Cr和APACHEⅡ评分明显降低(P<0.05),血pH值明显升高(P<0.05),而对照组病人在常规治疗12 h后的变化无统计学差异(P>0.05);SVVHDF组病人腹痛消失、腹胀缓解时间均较对照组明显缩短(P<0.05)。SVVHDF组病人在SVVHDF治疗4 h后RR、HR和CVP显著下降(P<0.05)。治疗6 h后MAP显著上升(P<0.05);治疗过程中电解质变化无统计学差异(P>0.05)。结论:早期应用SVVHDF能迅速缓解SAP合并AKI病人的症状和体征,显著改善病情并逆转肾功能不全。
Objective: To study the effect of early short-term intravenous-venous hemodiafiltration (SVVHDF) on the treatment of acute kidney injury (AKI) in patients with severe acute pancreatitis (SAP). Methods: 25 patients with AKI combined with SAP included SVVHDF group (n = 15) and control group (n = 10). The changes of serum creatinine (Cr), blood urea nitrogen (BUN), blood pH and APACHEⅡscore in both groups before and after treatment were monitored, and respiratory rate (RR), heart rate (HR) Mean arterial pressure (MAP), central venous pressure (CVP), electrolyte (K +, Na + and Cl-), clinical symptoms and signs of changes. Results: After 12 hours of SVVHDF treatment, the BUN, Cr and APACHEⅡ scores of SVVHDF group were significantly lower (P <0.05), and the pH value of blood was significantly higher (P <0.05), while those of control group were 12 hours after routine treatment There was no significant difference (P> 0.05). The pain disappeared and the duration of bloating relieved in SVVHDF group was significantly shorter than that in control group (P <0.05). The RR, HR and CVP of SVVHDF group decreased significantly (P <0.05) 4 h after SVVHDF treatment. After 6 h of treatment, MAP increased significantly (P <0.05). There was no significant difference in electrolytes during the treatment (P> 0.05). Conclusion: Early application of SVVHDF can quickly relieve the symptoms and signs of SAP patients with AKI, significantly improve the condition and reverse renal insufficiency.