论文部分内容阅读
目的通过比较目前常用一般治疗方法及联用连续性静脉-静脉血液滤过(CVVH)对重症急性胆管炎的治疗效果。方法随机将2011年12月-2015年3月在新疆兵团第一师医院ICU住院的44例重症胆管炎患者分为两组,对照组24例,给予常规药物治疗加PTCD治疗;受试组20例,给予除对照组治疗以外,另给予CVVH治疗;对入住重症医学科期间两组血管活性药物使用时间、机械通气时间、住ICU时间,治疗前及治疗3 d时肝功能(TBIL、ALT、ALP)、血乳酸、降钙素原(PCT)、WBC进行比较。结果 1治疗3d,除对照组PCT水平与治疗前相比差异无统计学意义外,受试组PCT及两组血乳酸、WBC、TBIL、ALT、ALP值较治疗前明显下降,差异有统计学意义(P<0.05);受试组PCT、血乳酸、WBC、TBIL、ALT、ALP较对照组有更明显的下降,差异有统计学意义。2受试组PCT、TBIL、ALT、ALP下降幅度及治疗3d乳酸清除率大于对照组,两组之间差异有统计学意义(P<0.01)。3受试组使用升压药物时间、机械通气时间、住ICU时间均明显短于对照组,两组间差异有统计学意义(P<0.01)。结论在常规药物及PTCD治疗基础上,加用CVVH治疗,有利于ACST伴发严重脓毒症控制,有利于肝功能改善,可以尽快稳定循环、改善组织灌注及氧合、尽早撤用呼吸机,最终较快较好地稳定病情。
Objective To compare the treatment effects of the commonly used general treatment and continuous veno-venous hemofiltration (CVVH) on severe acute cholangitis. Methods Forty-four patients with severe cholangitis admitted to the ICU of Xinjiang First Corps Hospital from December 2011 to March 2015 were randomly divided into two groups, control group (n = 24) and conventional drug treatment plus PTCD treatment. Patients in test group 20 For example, given CVVH in addition to the control group, CVVH was given to patients who were admitted to the intensive care unit during the period of admission to the Department of Critical Care Medicine, duration of mechanical ventilation, duration of ICU stay, pre- and post-treatment 3-day liver function (TBIL, ALT, ALP), blood lactate, procalcitonin (PCT), WBC. Results 1 After 3 days of treatment, the levels of PCT, Lactate, WBC, TBIL, ALT and ALP in the two groups were significantly lower than those before treatment except for the PCT level in the control group and before treatment, with statistical difference (P <0.05). The PCT, BLA, WBC, TBIL, ALT and ALP in the test group were significantly lower than those in the control group, the difference was statistically significant. The decrease of PCT, TBIL, ALT, ALP and the lactic acid clearance rate of 3d in treatment group were higher than those in control group. There was significant difference between the two groups (P <0.01). 3 The test group using the vasopressor time, mechanical ventilation time, live ICU time were significantly shorter than the control group, the difference between the two groups was statistically significant (P <0.01). Conclusions The combination of conventional treatment with PTCD and CVVH is conducive to the control of ACST with severe sepsis, which is conducive to the improvement of liver function, stabilization of circulation as soon as possible, improvement of tissue perfusion and oxygenation, withdrawal of ventilator as soon as possible, Ultimately better and better stable condition.