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目的观察脉冲式高容量血液滤过(PHVHF)治疗重症急性胰腺炎(SAP)的疗效。方法对2004年7月至2008年12月苏州大学附属第四人民医院收治的16例SAP患者在接受传统治疗方法的同时行PHVHF治疗,观察治疗前后临床症状、急性生理学及慢性健康状况评价Ⅱ(APACHⅡ)评分、生化指标的改变以及对愈后的影响。结果PHVHF治疗后,SAP患者腹痛、腹胀、发热、心动过速、呼吸窘迫等症状明显改善,APACHⅡ评分由治疗前15.93±3.06降至8.56±2.87(P<0.01),血清淀粉酶、转氨酶、肌酐、白细胞等均有下降,低氧血症、酸中毒纠正(P<0.01)。16例患者中14例存活,病死率为12.5%。结论PHVHF治疗SAP效果显著,降低病死率,可以作为SAP的重要辅助治疗。
Objective To observe the efficacy of pulsed high volume hemofiltration (PHVHF) in the treatment of severe acute pancreatitis (SAP). Methods Sixteen patients with SAP who were admitted to the Fourth People ’s Hospital of Soochow University from July 2004 to December 2008 underwent PHVHF while receiving traditional treatment methods. The clinical symptoms, acute physiology and chronic health status were evaluated before and after treatment Ⅱ ( APACH Ⅱ) score, changes in biochemical indicators and the impact on prognosis. Results The symptoms of abdominal pain, abdominal distension, fever, tachycardia and respiratory distress in SAP patients were significantly improved after PHVHF treatment. The APACH Ⅱ score decreased from 15.93 ± 3.06 to 8.56 ± 2.87 (P <0.01) before treatment, and the serum amylase, transaminase, creatinine , White blood cells, etc. were decreased, hypoxemia, acidosis corrected (P <0.01). Fourteen of 16 patients survived with a mortality rate of 12.5%. Conclusion PHVHF treatment of SAP significant effect, reduce mortality, SAP can be an important adjuvant therapy.