摘要
目的 观察腹膜透析（PD）和连续性血液净化（CBP）治疗重症急性胰腺炎（SAP）患者的疗效及效价比.方法 采用前瞻性随机对照研究,将38例SAP患者随机分为PD组（22例）和CBP组（16例）,观察两组治疗前后病情、生化指标和细胞因子的变化、预后、平均每日血液净化费用.结果 两组血液净化治疗后3 d血尿素氮（BUN）、肌酐（Cr）、谷丙转氨酶（ALT）、血淀粉酶（AMS）、脂肪酶（LPS）下降平均水平比较差异无统计学意义（P〉0.05）;PD组治疗48、72 h后白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）及急性生理和慢性健康状况评分Ⅱ（APACHEⅡ评分）均明显低于CBP组（P〈0.01）;两组患者中存活者所占比例差异无统计学意义（P〉0.05）,但PD 组脱离血液净化治疗时间明显较CBP组短（P〈0.01）,且PD组患者平均每日血液净化费用明显低于CBP组（P〈0.01）.结论 PD与CBP均能有效清除患者体内的各种炎症介质,稳定内环境,均是治疗SAP的有效方法,但PD能短期有效清除患者腹腔内和循环中的各种炎症介质,治疗时间短、费用低,是一种简单、经济、实用的方法.
Objective To compare the therapy efficiency and cost- effectiveness of peritoneal dialysis （PD） and continuous blood purification （CBP） in treatment of severe acute pancreatitis （SAP）. Methods A prospective randomized controlled trial was used in this study. 38 patients were randomly divided into 22 cases in group PD and 16 cases in group CBP. The clinical status, biochemical indicators and cytokines before and after treatment were recorded or measured, and the prognosis as well as the average daily cost of blood purification in two groups were observed. Results The average decrease level of blood urea nitrogen （ BUN）, creatinine （ Cr）, alanine aminotransferase （ ALT）, serum amylase （ AMS）, lipase （LPS） in two groups in 3 days did not show significant difference （ P 〉 O. 05 ）. IL - 6, IL - 8, TNF - ot and Acute Physiology and Chronic Health Evaluation （ APACHE ~ ） score were significantly lower in PD group than those in CBP group （P 〈0.01 ） after 48 h and 72 h; there was no significant difference of survival rate in the two groups （P 〉 0.05 ） ; but the treatment time of the blood purification was significantly shorter in the PD group than in the CBP group （ P 〈 0.01 ）. The average daily cost of blood purification in PD group was significantly lower than that in CBP group （P 〈 0. O1 ）. Conclusion PD and CBP are both effective methods in the treatment of SAP, which both can effectively remove the various inflammatory mediators in vivo and maintain homeostasis. But the various inflammatory mediators both in the abdominal cavity and in the intravascular in patients can be removed effectively during a relative short time period by PD, which indicates a simple, economical and practical method with the advantages of short cure time and low cost.
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第7期618-621,共4页
Chinese Journal of Critical Care Medicine
关键词
急性胰腺炎
重症
腹膜透析
连续性血液净化
疗效
效价比
Acute pancreatitis/severe
Peritoneal dialysis
Continuous blood purification
Curative effect
Cost - effectiveness
