区域动脉灌注联合血液净化治疗重症急性胰腺炎的临床研究

目的:探讨区域动脉灌注(CRAI)联合血液净化治疗重症急性胰腺炎(SAP)的临床疗效。方法:将2008年1月—2011年1月采用CRAI联合血液净化治疗的23例(灌注组)SAP患者与2005年1月—2007年12月采用传统方法治疗的26例SAP患者(传统组)的临床资料进行历史对照分析,比较两组治疗前后各项临床指标的变化情况及治疗效果。结果:治疗前两组各项临床指标无统计学差异(均P>0.05),治疗后第3,7天灌注组体温、心率、APACHE-II评分、白细胞计数、谷丙转氨酶和肌酐水平与传统组比较明显降低,而氧合指数、血小板计数明显增加(P<0.05或P<0.01);灌注组腹痛、腹胀消失时间及肠功能恢复时间和住院时间均短于传统组(均P<0.01);灌注组并发症发生率、中转手术率、病死率均低于传统组(P<0.05或P<0.01)。结论:CRAI联合血液净化治疗能提高SAP治愈率、降低病死率,减少并发症,是治疗重症急性胰腺炎的有效方法。

Combination of continuous regional arterial infusion and blood purification for severe acute pancreatitis

Objective: To investigate the clinical efficacy of continuous regional arterial infusion(CRAI) combined with blood purification therapy in treatment of severe acute pancreatitis(SAP). Methods: A historical comparative analysis was performed in the clinical data of 23 SAP patients from January 2008 to January 2011 undergoing CRAI plus blood purification therapy(CRAI group) and 26 SAP patients from January 2003 to September 2010 receiving traditional treatment(traditional group).The alterations of the clinical parameters before and after treatment,and therapeutic efficacies between the two groups were compared. Results: All the observed pre-treatment clinical variables had no obvious differences between the two groups(all P>0.05).On the third and seventh day after treatment,the body temperature,heart rate,APACHE-II score,white blood cell count,and levels of alanine transaminase and creatinine significantly decreased and the oxygenation index and platelet count significantly increased in CRAI group compared with traditional group(P<0.05 or P<0.01).The length of time of abdominal pain and for distension resolution,bowel function recovery and hospital stay in CRAI group were all shorter than those in traditional group(all P<0.01).Furthermore,the incidence of complications,surgical conversion rate and mortality of CRAI group were all significantly lower than those of traditional group(P<0.05 or P<0.01). Conclusion: Combination of CRAI and blood purification can improve the cure rate and reduce the complications of SAP,so it is an effective modality of treatment for SAP.