应用CRRT治疗SAP相关肾损伤疗效的回顾性分析

发布时间：2018-05-04 14:07

  本文选题：连续性肾脏替代治疗 + 重症急性胰腺炎相关性肾损伤　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:回顾性分析CRRT在重症急性胰腺炎相关性肾损伤治疗中的疗效。方法:回顾性分析大连医科大学附属第一医院急诊ICU 2013年6月-2016年6月收治的重症急性胰腺炎相关性肾损伤患者48例,依据患者是否行CRRT治疗将患者分为两组,A组:行CRRT治疗组;B组:未行CRRT治疗组;所有病例均接受其它常规综合治疗。回顾A、B两组患者临床资料中,治疗前、治疗后24小时、治疗后48小时生命体征、平均动脉压、尿量、血白细胞、血生化、动脉血气分析等相关指标,评估患者APACHE II评分及改良Marshall评分。结果:①生命体征、平均动脉压及尿量:A组患者行CRRT治疗24小时后心率逐渐稳定,呼吸频率恢复至正常范围内;患者尿量明显增多,并持续到48小时仍有统计学意义(P0.05);体温及平均动脉压在接受治疗48小时后明显改善(P0.05),体温基本恢复至正常范围内,差异有统计学意义。B组患者经治疗48小时后,呼吸频率基本恢复正常,其余各项指标较入院时比较,差异无统计学意义。②血生化及血白细胞:A组患者在接受治疗后24小时,其反映病情严重程度及器官功能的指标:BUN、Scr、AMY、LPS明显下降,反映患者感染控制的指标WBC也得到明显改善,并持续到48小时(P0.05),差异有统计学意义。B组患者接受治疗后WBC在24小时得到改善、AMY在48小时得到改善(P0.05)。③血气分析相关指标:A组患者治疗24小时后PH值即稳定在正常范围,P02、PC02得到明显改善(P0.05),并持续到48小时仍有效;血钠及血钾在48小时内得到恢复,维持在稳定范围内,并较入院时明显改善(P0.05),血钙明显升高,并趋于正常范围,血乳酸明显下降(P0.05);B组患者接受治疗后,PH、PC02在48小时内得到改善,有统计学意义(P0.05),其余各项指标较入院时比较均无统计学意义。④患者的APACHE Ⅱ评分及改良Marshall评分:A组患者接受治疗后24小时APACHE Ⅱ评分及改良Marshall评分较入院时明显下降(P0.05),并持续到48小时,评分改善更明显;B组患者经过治疗,在48小时后APACHE Ⅱ评分及改良Marshall评分较入院时改善(P0.05);对比A、B两组患者的APACHE Ⅱ评分及改良Marshall评分,B组患者评分改善速度、程度均不如A组患者明显,差异有统计学意义(P0.05)。结论:以上研究结果显示,重症急性胰腺炎相关性肾损伤患者在入院后早期(入院24小时内)即行CRRT治疗,能得到较好疗效。对比非CRRT治疗组,CRRT联合保守治疗能有效阻断患者病情进展,改善患者生命体征及生化指标,有利于减轻患者心、肺、肾脏等器官功能的损害程度,改善患者免疫状态、维持患者体内水、电解质、内环境稳态,对患者预后有积极意义。
[Abstract]:Objective: to retrospectively analyze the efficacy of CRRT in the treatment of renal injury associated with severe acute pancreatitis. Methods: a retrospective analysis of 48 patients with severe acute pancreatitis associated renal injury admitted from June 2013 to June 2016 in emergency department ICU, the first affiliated Hospital of Dalian Medical University, was performed. Patients were divided into two groups according to whether they were treated with CRRT: group A: group B: group B: group B: no CRRT, all patients received other routine combined therapy. To review the clinical data of two groups of patients, including vital signs, mean arterial pressure, urine volume, white blood cell, blood biochemistry, arterial blood gas analysis and so on, before treatment, 24 hours after treatment and 48 hours after treatment. APACHE II score and modified Marshall score were evaluated. Results after 24 hours of CRRT treatment, the heart rate gradually stabilized and the respiratory rate returned to the normal range, and the urine volume of the patients increased significantly in the group of 1: 1 vital signs, the mean arterial pressure and the urine volume of the patients in group A were treated with CRRT for 24 hours. After 48 hours of treatment, the body temperature and mean arterial pressure were significantly improved and the body temperature returned to normal range, and the difference was statistically significant after 48 hours of treatment. The respiratory frequency basically returned to normal, and the other indexes were not significantly different from those at admission. 2. There was no significant difference in blood biochemistry and leukocyte in group A 24 hours after treatment. WBC, an index reflecting the severity of the disease and organ function, was significantly decreased, and WBC, the indicator of infection control, was also significantly improved. The difference was statistically significant. WBC was improved at 24 hours after treatment in group B. The blood gas analysis index of group B was stable at positive value after 24 hours treatment. P0.05.3 Blood gas analysis index: 0. 05% after 24 hours of treatment, the PH value of group B was stable at a positive level. P02P02 was significantly improved in the normal range and continued to be effective for 48 hours. Blood sodium and potassium were recovered within 48 hours, maintained in a stable range, and significantly improved compared with those at admission (P 0.05), blood calcium increased significantly and tended to normal range. In group B, serum lactate decreased significantly and PHPC02 was improved within 48 hours after treatment. There was statistical significance (P 0.05). The other indexes were significantly lower than those on admission in APACHE 鈪，

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